Jackson, Lenley Bradford

Jackson, Lenley Bradford is an individual health care provider with primary practice located at 516 East Nizhoni Blvd. , Gallup NM 87301-1337. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Jackson, Lenley Bradford can be contacted via phone (505) 722-1000.

Contact Information

Primary practice address
516 East Nizhoni Blvd. Gallup NM 87301-1337
Phone: (505) 722-1000
Fax: (505) 726-8740
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X A87877 California
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 036-119364 Illinois

Profile Details

NPI number 1568555845
LBN Legal business name Jackson, Lenley Bradford
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 1st, 2006
Last updated Nov 14th, 2011 - about 13 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 1568555845 NPPES
Illinois MEDICAID 036119364
Illinois Other R00965
Illinois Other 833120
Illinois Other P00601866
Illinois Other CA2264

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