Jackson, Roosevelt T
Jackson, Roosevelt T is an sole proprietor health care provider with primary practice located at 31 W 20Th St Ste 100 , Riviera Beach FL 33404-6155. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Ophthalmology, Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Addiction Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Jackson, Roosevelt T can be contacted via phone (561) 510-0471.Contact Information
Primary practice address
31 W 20Th St Ste 100
Riviera Beach FL 33404-6155
Phone: (561) 510-0471
Fax: (561) 331-2715
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | ME45529 | Florida |
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | ME45529 | Florida |
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | ME45529 | Florida |
| Allopathic & Osteopathic Physicians / Addiction Medicine | 207QA0401X | ME45529 | Florida |
Profile Details
| NPI number | 1295951374 |
|---|---|
| LBN Legal business name | Jackson, Roosevelt T |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 17th, 2007 |
| Last updated | Dec 17th, 2018 - about 6 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 | 1295951374 | NPPES |
| Florida | MEDICAID | 043150800 |
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