MEDICARE: DR. ERIC STEED JACKSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01047256A	IN

General Provider Information

NPI Number	:	1245317429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC STEED JACKSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1510
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47706-1510
Country	:	US
Telephone Number	:	812-868-0530
Fax Number	:	812-868-2188

Provider Business Practice Location Address
First Line	:	1033 E MOUNT PLEASANT RD
Second Line	:	SUITE D
City	:	EVANSVILLE
State	:	IN
Zip	:	47725-7149
Country	:	US
Telephone Number	:	812-868-0530
Fax Number	:	812-868-2188

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	12/16/2014

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