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NPI Code Detail

MEDICARE: DR. MICHAEL E JACKSON M.D.

MEDICARE: DR. MICHAEL E 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
1207P00000XEmergency Medicine Physician10306NV

General Provider Information

NPI Number : 1437131331
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL E JACKSON M.D.
Provider Business Mailing Address
First Line : 11103 KILKERRAN CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89141-4356
Country : US
Telephone Number : 702-614-4576
Fax Number : 702-614-4576
Provider Business Practice Location Address
First Line : 11103 KILKERRAN CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89141-4356
Country : US
Telephone Number : 702-614-4576
Fax Number : 702-614-4576
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2005
Last Update Date : 07/08/2007

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