Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 01065052A | IN |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 12911 | NV |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 8687 | MT |
NPI | 1235236308 |
---|---|
Provider Name | Dr. David Neal Jackson |
First Address | Las Vegas, NV 89102-2325 |
Second Address | Las Vegas, NV 89102-2351 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 23/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017663 | (05) | MT |
01065052A | STATE LICENSE (01) | IN |
12911 | STATE LICENSE (01) | NV |
8687 | STATE LICENSE (01) | MT |
EO7522 | (02) | MT |