MEDICARE: DANIEL RAY JACKSON MD, MPH

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
1	208600000X	Surgery Physician	R82485	AZ

General Provider Information

NPI Number	:	1972221513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL RAY JACKSON MD, MPH

Provider Business Mailing Address
First Line	:	1501 N CAMPELL AVE
Second Line	:	ROOM 5304D
City	:	TUCSON
State	:	AZ
Zip	:	85724-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 N CAMPBELL AVE RM 5304D
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85724-0001
Country	:	US
Telephone Number	:	520-626-9540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2022
Last Update Date	:	05/08/2026

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