MEDICARE: MATTHEW PAUL JACKSON D.O.

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	207RG0100X	Gastroenterology Physician	009335	AZ

General Provider Information

NPI Number	:	1265813349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW PAUL JACKSON D.O.

Provider Business Mailing Address
First Line	:	14339 N 98TH PL
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-3847
Country	:	US
Telephone Number	:	815-351-3929
Fax Number	:

Provider Business Practice Location Address
First Line	:	4540 E BASELINE RD STE 115
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4617
Country	:	US
Telephone Number	:	480-306-6405
Fax Number	:	480-361-6108

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

Provider Enumeration Date	:	06/15/2015
Last Update Date	:	12/01/2025

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