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General NPI Number Information
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NPI Number | 1225022809
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Entity Type | Individual
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Provider Name | FRANCES M JACKSON MD
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Gender | Female
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 1223 S GEAR AVE STE 108
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City | WEST BURLINGTON
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State | IA
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Zip | 52655-1682
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Country | US
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Telephone | 319-753-5177
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Fax | 319-753-0893
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Provider Business Mailing Address
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Address Line | 200 HAWKINS DR
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City | IOWA CITY
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State | IA
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Zip | 52242-1009
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Country | US
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Telephone | 319-356-1474
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Fax | 319-356-3715
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 27505
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License Number State | IA
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