Jackson, Mark A

Jackson, Mark A is an sole proprietor health care provider with primary practice located at 1000 Pavilions Circle Mark A Jackson Md Plc, Traverse City MI 49684. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Geriatric Medicine. Allopathic & Osteopathic Physicians / Geriatric Medicine is his primary health care specialty. Jackson, Mark A can be contacted via phone (231) 935-0913.

Contact Information

Primary practice address
1000 Pavilions Circle Mark A Jackson Md Plc Traverse City MI 49684
Phone: (231) 935-0913
Fax: (231) 935-0984
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 051555 Michigan
Allopathic & Osteopathic Physicians / Geriatric Medicine 207QG0300X 4301051555 Michigan

Profile Details

NPI number 1073585238
LBN Legal business name Jackson, Mark A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 2nd, 2006
Last updated Oct 23rd, 2015 - about 9 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 1073585238 NPPES
Michigan MEDICAID 1820487
Michigan Other 080B86010

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