Jackson, Kevin Gordon

Jackson, Kevin Gordon is an individual health care provider with primary practice located at 7600 N 16Th St Ste 112 , Phoenix AZ 85020-4446. He recently has only one registered license in Allopathic & Osteopathic Physicians / Geriatric Medicine, which is considered as his primary health care specialty. Jackson, Kevin Gordon can be contacted via phone (602) 830-0605.

Contact Information

Primary practice address
7600 N 16Th St Ste 112 Phoenix AZ 85020-4446
Phone: (602) 830-0605
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Geriatric Medicine 207QG0300X 22105 Arizona

Profile Details

NPI number 1225032782
LBN Legal business name Jackson, Kevin Gordon
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 11th, 2005
Last updated Apr 13th, 2023 - about 3 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 1225032782 NPPES
Arizona MEDICAID 428525
Arizona Other AZ0728320

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