Jackson, Kevin Gordon
Jackson, Kevin Gordon is an individual health care provider with primary practice located at 7600 N 16Th St Ste 112 , Phoenix AZ 85020-4446. He recently has only one registered license in Allopathic & Osteopathic Physicians / Geriatric Medicine, which is considered as his primary health care specialty. Jackson, Kevin Gordon can be contacted via phone (602) 830-0605.Contact Information
Primary practice address
7600 N 16Th St Ste 112
Phoenix AZ 85020-4446
Phone: (602) 830-0605
Fax:
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Geriatric Medicine | 207QG0300X | 22105 | Arizona |
Profile Details
NPI number | 1225032782 |
---|---|
LBN Legal business name | Jackson, Kevin Gordon |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Jun 11th, 2005 |
Last updated | Apr 13th, 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 | 1225032782 | NPPES |
Arizona | MEDICAID | 428525 | |
Arizona | Other | AZ0728320 |
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