Jackson, Shawn Barrett

Jackson, Shawn Barrett is an individual health care provider with primary practice located at 1000 E Primrose St Ste 550 , Springfield MO 65807-5180. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatopathology, Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology. Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology is his primary health care specialty. Jackson, Shawn Barrett can be contacted via phone (417) 269-4646.

Contact Information

Primary practice address
1000 E Primrose St Ste 550 Springfield MO 65807-5180
Phone: (417) 269-4646
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatopathology 207ZD0900X 2005005716 Missouri
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X 2005005716 Missouri

Profile Details

NPI number 1730258708
LBN Legal business name Jackson, Shawn Barrett
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 6th, 2006
Last updated May 4th, 2017 - about 7 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 1730258708 NPPES
Missouri MEDICAID 700100407
Missouri Other 1101160
Missouri Other 421539307
Missouri Other 1559
Missouri Other 431451388
Missouri Other 159012
Missouri MEDICAID 705866705

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