Jackson, Allen Thomas
Jackson, Allen Thomas is an individual health care provider with primary practice located at 1201 S Ridgewood Ave , Daytona Beach FL 32114-6123. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Jackson, Allen Thomas can be contacted via phone (386) 492-7718.Contact Information
Primary practice address
1201 S Ridgewood Ave
Daytona Beach FL 32114-6123
Phone: (386) 492-7718
Fax: (386) 492-7720
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | ME80695 | Florida |
Profile Details
NPI number | 1932151479 |
---|---|
LBN Legal business name | Jackson, Allen Thomas |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | May 16th, 2006 |
Last updated | Mar 7th, 2023 - about last year |
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 | 1932151479 | NPPES |
Florida | MEDICAID | 001628800 |
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