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General NPI Number Information
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NPI Number | 1760412076
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Entity Type | Individual
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Provider Name | T. SCOTT JACKSON MD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 4131 OREGON PIKE
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City | BROWNSTON
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State | PA
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Zip | 17508
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Country | US
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Telephone | 717-859-1123
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Fax | 717-859-2898
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Provider Business Mailing Address
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Address Line | 4131 OREGON PIKE SUITE C
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City | EPHRATA
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State | PA
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Zip | 17522-9550
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Country | US
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Telephone | 717-859-5161
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Fax | 717-859-5169
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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 | MD029835E
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License Number State | PA
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