Lilly, Albert Jackson

Lilly, Albert Jackson is an individual health care provider with primary practice located at 61250 Se Coombs Pl , Bend OR 97702-3704. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Lilly, Albert Jackson can be contacted via phone (541) 706-5930.

Contact Information

Primary practice address
61250 Se Coombs Pl Bend OR 97702-3704
Phone: (541) 706-5930
Fax: (541) 706-5931
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X MD22604 Oregon

Profile Details

NPI number 1285677955
LBN Legal business name Lilly, Albert Jackson
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2006
Last updated Apr 17th, 2020 - 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 1285677955 NPPES
Arizona MEDICAID 958936

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