Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 009007 | AZ |
NPI | 1063472926 |
---|---|
Provider Name | William H Jackson |
First Address | Phoenix, AZ 85006-2837 |
Second Address | Phoenix, AZ 85006-2502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
233479 | (05) | AZ |
D44066 | (02) |