Jackson, Edward Leslie
Jackson, Edward Leslie is an individual health care provider with primary practice located at 3344 N Futrall Dr , Fayetteville AR 72703-4057. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Critical Care Medicine, Allopathic & Osteopathic Physicians / Pulmonary Disease. Allopathic & Osteopathic Physicians / Pulmonary Disease is his primary health care specialty. Jackson, Edward Leslie can be contacted via phone (479) 521-8200.Contact Information
Primary practice address
3344 N Futrall Dr
Fayetteville AR 72703-4057
Phone: (479) 521-8200
Fax: (479) 582-7310
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Critical Care Medicine | 207RC0200X | E-4775 | Arkansas |
| Allopathic & Osteopathic Physicians / Pulmonary Disease | 207RP1001X | E-4775 | Arkansas |
Profile Details
| NPI number | 1174506448 |
|---|---|
| LBN Legal business name | Jackson, Edward Leslie |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 21st, 2005 |
| Last updated | Mar 14th, 2024 - 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 | 1174506448 | NPPES |
| Arkansas | Other | 5N545 | AR BCBS |
| Arkansas | Other | P00327943 | AR BCBS |
| Arkansas | MEDICAID | 160768001 | AR BCBS |
| Arkansas | MEDICAID | 200088310A | AR BCBS |
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