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NPI Code Detail

MEDICARE: MRS. MELINDA ANN JACKSON

MEDICARE: MRS. MELINDA ANN JACKSON
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
1207RG0300XGeriatric Medicine (Internal Medicine) PhysicianMD12772OR

General Provider Information

NPI Number : 1558330647
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MELINDA ANN JACKSON
Provider Business Mailing Address
First Line : 13007 NE GLISAN ST
Second Line :
City : PORTLAND
State : OR
Zip : 97230-2545
Country : US
Telephone Number : 503-215-6556
Fax Number : 503-215-0685
Provider Business Practice Location Address
First Line : 13007 NE GLISAN ST
Second Line :
City : PORTLAND
State : OR
Zip : 97230-2545
Country : US
Telephone Number : 503-215-6556
Fax Number : 503-215-0685
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. MELINDA ANN JACKSON ” Practice Location

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