MEDICARE: DAVID M JACKSON MD

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	207X00000X	Orthopaedic Surgery Physician	35407273	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659392074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID M JACKSON MD

Provider Business Mailing Address
First Line	:	1980 TAMARACK RD
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-1363
Country	:	US
Telephone Number	:	740-788-9220
Fax Number	:	740-788-9226

Provider Business Practice Location Address
First Line	:	1980 TAMARACK RD
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-1363
Country	:	US
Telephone Number	:	740-788-9220
Fax Number	:	740-788-9226

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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