Timothy L Jackson PA-C

NPI 1982623625 - Physician Assistant - 363A00000X

NPI Details
NPI 1982623625
Gender Male
Enumeration Date 07/19/2006
Last Updated 10/16/2008
Entity Type Individual
Active Over 10 years ago
Practice Location
5249 PROVIDENCE RD
VIRGINIA BEACH VA, 23464-4201, US
Phone (757) 467-3900
Fax (757) 467-3158
Business Location
5249 PROVIDENCE RD
VIRGINIA BEACH VA, 23464-4201, US
Phone (757) 467-3900
Fax (757) 467-3158
Toxanomy
Taxonomy Code 363A00000X
License State Virginia
License Number 0110002037
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According to our database, Timothy L Jackson PA-C NPI is 1982623625, taxonomy code is 363A00000X and license number is 0110002037, license state is located at Virginia. Timothy L Jackson PA-C physically located at 5249 Providence Rd, Virginia Beach VA, 23464-4201. NPI Number Timothy L Jackson PA-C has the Individual type.

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1982623625 NPI number is provided on an as is basis without warranty of any kind. 1982623625 is maintained by the National Plan & Provider Enumeration System. The contents of Timothy L Jackson PA-C are for informational purposes only.