Jackson, Alfred Vaughn D
Jackson, Alfred Vaughn D is an sole proprietor health care provider with primary practice located at 416 Main Street , La Jara CO 81140-0272. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Jackson, Alfred Vaughn D can be contacted via phone (719) 274-4500.Contact Information
Primary practice address
416 Main Street
La Jara CO 81140-0272
Phone: (719) 274-4500
Fax: (719) 274-4504
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 1823241205 | Utah |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 89132 | New Mexico |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 31351 | Colorado |
Profile Details
| NPI number | 1891746707 |
|---|---|
| LBN Legal business name | Jackson, Alfred Vaughn D |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 15th, 2006 |
| Last updated | Nov 13th, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891746707 | NPPES |
| Colorado | MEDICAID | 01313519 | |
| Colorado | MEDICAID | 89132 |
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