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General NPI Number Information
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NPI Number | 1538439302
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Entity Type | Organization
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Legal Business Name | ERIC JACKSON-SCOTT MD INC
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Dates
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Enumeration Date | 01/10/2012
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 455 N PRAIRIE AVE
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City | INGLEWOOD
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State | CA
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Zip | 90301-1413
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Country | US
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Telephone | 310-412-0183
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Fax |
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Provider Business Mailing Address
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Address Line | 2355 WESTWOOD BLVD STE 609
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City | LOS ANGELES
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State | CA
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Zip | 90064-2109
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Country | US
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Telephone | 310-948-0485
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ERIC JACKSON-SCOTT
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Credential | MD
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Telephone | 310-948-0485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A115195
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License Number State | CA
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