Jackson, Edward Robert

Jackson, Edward Robert is an individual health care provider with primary practice located at 3334 Capital Medical Blvd #400 , Tallahassee FL 32308-4470. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is his primary health care specialty. Jackson, Edward Robert can be contacted via phone (850) 877-8174.

Contact Information

Primary practice address
3334 Capital Medical Blvd #400 Tallahassee FL 32308-4470
Phone: (850) 877-8174
Fax: (850) 877-5636
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X BP10016960 Texas
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X ME107624 Florida
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 063075 Georgia
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X 63075 Georgia

Profile Details

NPI number 1710129408
LBN Legal business name Jackson, Edward Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 27th, 2009
Last updated Sep 13th, 2022 - about 3 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 1710129408 NPPES
Florida Other 003214650 UNITED HEALTH CARE
Florida Other 250872 UNITED HEALTH CARE
Florida MEDICAID 002458400 UNITED HEALTH CARE
Florida Other P00903177 UNITED HEALTH CARE
Florida MEDICAID 503370302B UNITED HEALTH CARE

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