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General NPI Number Information
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NPI Number | 1184602666
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Entity Type | Individual
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Provider Name | ORLAN JACKSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 1312 HIGHWAY 49 N
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City | BEULAH
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State | ND
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Zip | 58523-6038
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Country | US
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Telephone | 701-873-4445
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Fax | 701-873-4199
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Provider Business Mailing Address
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Address Line | 1312 HIGHWAY 49 N
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City | BEULAH
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State | ND
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Zip | 58523-6038
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Country | US
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Telephone | 701-873-4445
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Fax | 701-873-4199
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ND5650
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License Number State | ND
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