Jackson, John

Jackson, John is an individual health care provider with primary practice located at 111 Nw 183Rd St Ste 306 , Miami FL 33169. He recently has only one registered license in Allopathic & Osteopathic Physicians / General Practice, which is considered as his primary health care specialty. Jackson, John can be contacted via phone (305) 705-6688.

Contact Information

Primary practice address
111 Nw 183Rd St Ste 306 Miami FL 33169
Phone: (305) 705-6688
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X 37656 Florida
Allopathic & Osteopathic Physicians / General Practice 208D00000X ME37656 Florida

Profile Details

NPI number 1184607541
LBN Legal business name Jackson, John
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 21st, 2005
Last updated Mar 27th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184607541 NPPES
Florida MEDICAID 025035200

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