Jackson, Michael Darren

Jackson, Michael Darren is an individual health care provider with primary practice located at 6644 E. Baywood Ave. Banner Baywood Emergency Department, Mesa AZ 85206. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Jackson, Michael Darren can be contacted via phone (480) 321-0183.

Contact Information

Primary practice address
6644 E. Baywood Ave. Banner Baywood Emergency Department Mesa AZ 85206
Phone: (480) 321-0183
Fax: (480) 321-0402
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 1987 Arizona

Profile Details

NPI number 1154394039
LBN Legal business name Jackson, Michael Darren
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 10th, 2006
Last updated Jul 23rd, 2013 - about 13 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 1154394039 NPPES
Arizona MEDICAID 371956

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