Jackson, Allen Charles

Jackson, Allen Charles is an individual health care provider with primary practice located at 624 Hospital Dr , Mountain Home AR 72653-2955. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Jackson, Allen Charles can be contacted via phone (870) 365-2076.

Contact Information

Primary practice address
624 Hospital Dr Mountain Home AR 72653-2955
Phone: (870) 365-2076
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X R3563 Arkansas

Profile Details

NPI number 1477544955
LBN Legal business name Jackson, Allen Charles
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 2nd, 2005
Last updated Feb 19th, 2019 - about 5 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477544955 NPPES
Arkansas MEDICAID 112301001

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