Jackson, Jerilyn De Von

Jackson, Jerilyn De Von is an individual health care provider with primary practice located at 1110 N Dutton Ave , Santa Rosa CA 95401-4606. She recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as her primary health care specialty. Jackson, Jerilyn De Von can be contacted via phone (707) 303-3600.

Contact Information

Primary practice address
1110 N Dutton Ave Santa Rosa CA 95401-4606
Phone: (707) 303-3600
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X G67649 California

Profile Details

NPI number 1962446575
LBN Legal business name Jackson, Jerilyn De Von
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 15th, 2006
Last updated Jul 25th, 2018 - about 7 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 1962446575 NPPES
California MEDICAID 00G676492

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