Jackson, Phillip Corey
Jackson, Phillip Corey is an individual health care provider with primary practice located at 1417 Gladden St , Harrison AR 72601-5121. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Jackson, Phillip Corey can be contacted via phone (870) 741-0016.Contact Information
Primary practice address
1417 Gladden St
Harrison AR 72601-5121
Phone: (870) 741-0016
Fax: (870) 741-4242
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | E3074 | Arkansas |
Profile Details
| NPI number | 1548227481 |
|---|---|
| LBN Legal business name | Jackson, Phillip Corey |
| Credentials | MD PA |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 26th, 2006 |
| Last updated | Aug 11th, 2014 - about 10 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1548227481 | NPPES |
| Arkansas | MEDICAID | 146189001 | |
| Arkansas | Other | 5M007 |
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