Jackson, Scott M
Jackson, Scott M is an individual health care provider with primary practice located at 4375 N Vantage Dr Ste 305 , Fayetteville AR 72703-4984. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Jackson, Scott M can be contacted via phone (479) 273-7006.Contact Information
Primary practice address
4375 N Vantage Dr Ste 305
Fayetteville AR 72703-4984
Phone: (479) 273-7006
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | E13748 | Arkansas |
Profile Details
| NPI number | 1336267509 |
|---|---|
| LBN Legal business name | Jackson, Scott M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 27th, 2007 |
| Last updated | Feb 22nd, 2022 - about 2 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 | 1336267509 | NPPES |
| Arkansas | MEDICAID | 261960001 |
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