Jackson, Mark K

Jackson, Mark K is an individual health care provider with primary practice located at 110 W 6Th St , Oswego NY 13126-2507. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Jackson, Mark K can be contacted via phone (315) 349-5000.

Contact Information

Primary practice address
110 W 6Th St Oswego NY 13126-2507
Phone: (315) 349-5000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 196101 New York

Profile Details

NPI number 1063405538
LBN Legal business name Jackson, Mark K
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 30th, 2005
Last updated Sep 13th, 2007 - about 17 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 1063405538 NPPES
New York MEDICAID 01880015

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