Jackson, Timothy K

Jackson, Timothy K is an individual health care provider with primary practice located at 710 Genesis Blvd , Bridgeport WV 26330-9668. He recently has only one registered license in Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism, which is considered as his primary health care specialty. Jackson, Timothy K can be contacted via phone (681) 342-3070.

Contact Information

Primary practice address
710 Genesis Blvd Bridgeport WV 26330-9668
Phone: (681) 342-3070
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X 13532 West Virginia

Profile Details

NPI number 1255444766
LBN Legal business name Jackson, Timothy K
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 17th, 2006
Last updated Apr 6th, 2022 - about 4 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 1255444766 NPPES
West Virginia MEDICAID 0084315000

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