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General NPI Number Information
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NPI Number | 1659452092
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Entity Type | Organization
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Legal Business Name | ROY HARPER JACKSON M D INC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 65 N MADISON AVE STE 709
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City | PASADENA
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State | CA
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Zip | 91101-2046
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Country | US
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Telephone | 626-792-4185
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Fax | 626-792-7358
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Provider Business Mailing Address
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Address Line | 65 N MADISON AVE STE 709
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City | PASADENA
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State | CA
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Zip | 91101-2046
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Country | US
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Telephone | 626-792-4185
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Fax | 626-792-7358
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | DR. ROY HARPER JACKSON
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Credential | M.D.
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Telephone | 626-792-4185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G30184
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License Number State | CA
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