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General NPI Number Information
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NPI Number | 1972434470
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Entity Type | Individual
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Provider Name | MATTHEW BRENNAN JACKSON
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Gender | Male
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Dates
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Enumeration Date | 05/26/2026
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Last Update Date | 05/26/2026
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Provider Practice Location Address
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Address Line | CMED 1632 STONE ST
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City | SAGINAW
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State | MI
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Zip | 48602
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Country | US
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Telephone | 989-583-6595
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Fax |
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Provider Business Mailing Address
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Address Line | 7762 JON SCOTT DR
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City | GRAND LEDGE
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State | MI
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Zip | 48837-9279
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Country | US
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Telephone | 517-214-4383
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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