Jackson, Rodger Dale

Jackson, Rodger Dale is an sole proprietor health care provider with primary practice located at 6777 W Maple Rd Department Of Emergency Medicine, West Bloomfield MI 48322-3013. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Jackson, Rodger Dale can be contacted via phone (313) 614-2186.

Contact Information

Primary practice address
6777 W Maple Rd Department Of Emergency Medicine West Bloomfield MI 48322-3013
Phone: (313) 614-2186
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 5101016798 Michigan
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 5101016798 Michigan

Profile Details

NPI number 1588795546
LBN Legal business name Jackson, Rodger Dale
Credentials DO, MPH
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 8th, 2007
Last updated Jan 22nd, 2013 - about 11 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 1588795546 NPPES
Michigan Other 5101016798 LICENSE
Michigan Other 5315026355 LICENSE

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