Jackson, Richard D

Jackson, Richard D is an individual health care provider with primary practice located at 29 Eastbrook Rd , Ronks PA 17572-9769. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Jackson, Richard D can be contacted via phone (717) 299-5711.

Contact Information

Primary practice address
29 Eastbrook Rd Ronks PA 17572-9769
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD031678E Pennsylvania

Profile Details

NPI number 1366483406
LBN Legal business name Jackson, Richard D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 9th, 2006
Last updated Jul 8th, 2007 - about 17 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 1366483406 NPPES
Pennsylvania MEDICAID 1160742

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