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General NPI Number Information
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NPI Number | 1568555845
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Entity Type | Individual
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Provider Name | LENLEY BRADFORD JACKSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/01/2006
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 2505 W HAMMER LN
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City | STOCKTON
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State | CA
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Zip | 95209-2839
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Country | US
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Telephone | 209-954-4040
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Fax | 209-951-2239
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Provider Business Mailing Address
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Address Line | PO BOX 255228
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City | SACRAMENTO
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State | CA
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Zip | 95865-5228
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Country | US
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Telephone | 800-470-0071
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Fax | 916-854-6769
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 15431
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A87877
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License Number State | CA
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