Jackson, William

Jackson, William is an individual health care provider with primary practice located at 1441 Ne 10Th Ave , Payette ID 83661-5420. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Jackson, William can be contacted via phone (208) 642-9376.

Contact Information

Primary practice address
1441 Ne 10Th Ave Payette ID 83661-5420
Phone: (208) 642-9376
Fax: (208) 642-9279
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD187049 Oregon
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X M-14093 Idaho

Profile Details

NPI number 1740530302
LBN Legal business name Jackson, William
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 11th, 2012
Last updated Apr 12th, 2019 - about 7 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 1740530302 NPPES
Idaho Other M-14093 STATE OF IDAHO MEDICAL LICENSE
Idaho Other MD187049 STATE OF IDAHO MEDICAL LICENSE

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