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NPI Code Detail

MEDICARE: DR. WILLIAM LORENZO JACKSON M.D., PH.D.

MEDICARE: DR. WILLIAM LORENZO JACKSON M.D., PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician27784TN
2207RI0200XInfectious Disease PhysicianMD-22640HI
3207R00000XInternal Medicine PhysicianMD-22640HI

General Provider Information

NPI Number : 1316144215
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM LORENZO JACKSON M.D., PH.D.
Provider Business Mailing Address
First Line : 46-172 HILINAMA ST
Second Line :
City : KANEOHE
State : HI
Zip : 96744-3604
Country : US
Telephone Number : 808-861-8530
Fax Number :
Provider Business Practice Location Address
First Line : 500 ALA MOANA BLVD STE 7400
Second Line :
City : HONOLULU
State : HI
Zip : 96813-4902
Country : US
Telephone Number : 808-354-5987
Fax Number : 808-468-4548
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2007
Last Update Date : 04/10/2025

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