Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 266924 | MA |
NPI | 1053601765 |
---|---|
Provider Name | Dr. Christopher Ryan Jackson |
First Address | Hyannis, MA 02601-3009 |
Second Address | Hyannis, MA 02601-3009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2011 |
Last Update Date | 21/12/2016 |