Kenneth Douglas Jackson M.D.

NPI 1073510491 - Family Medicine - 207Q00000X

NPI Details
NPI 1073510491
Gender Male
Enumeration Date 06/30/2005
Last Updated 07/08/2007
Entity Type Individual
Active Over 11 years ago
Practice Location
1739 E BEVERLY AVE
SUITE 201
KINGMAN AZ, 86401-3593, US
Phone (928) 692-3456
Fax (928) 692-7071
Business Location
1739 E BEVERLY AVE
SUITE 201
KINGMAN AZ, 86401-3593, US
Phone (928) 692-3456
Fax (928) 692-7071
Toxanomy
Taxonomy Code 207Q00000X
License State Arizona
License Number 12522
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According to our database, Dr. Kenneth Douglas Jackson M.D. NPI is 1073510491, taxonomy code is 207Q00000X and license number is 12522, license state is located at Arizona. Kenneth Douglas Jackson M.D. physically located at 1739 E Beverly Ave, Kingman AZ, 86401-3593. NPI Number Kenneth Douglas Jackson M.D. has the Individual type.

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1073510491 NPI number is provided on an as is basis without warranty of any kind. 1073510491 is maintained by the National Plan & Provider Enumeration System. The contents of Kenneth Douglas Jackson M.D. are for informational purposes only.