Male or Other

Mr. David M. Jackson PA-C

Medical Physician Assistant in Orange City, FL(View on Map)

Full Name

Mr. David M Jackson PA-C

NPI Number

1952338485

NPI Type

Individual Provider

Gender

Male

Enumeration Date

06/28/2006

Specialties

(Taxonomies)

Code

363AM0700X

Primary Taxonomy

Yes

Licenses

State

Florida
Virginia

License Number

9104510
01108408409

Contact
Information

Purpose

Mailing
Location

Address

2223 ASTOR ST
1133 SAXON BLVD

City

Orange Park
Orange City

State

FL
FL

Postal Code

32073-5668
32763-0000

Country

US
US

Telephone Number

(904) 305-3221
(904) 305-3221

Identifiers

Identifier

003373900
Y06YY

Identifier State

FL
Unknown

Identifier Issuer

Unknown
BCBS

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 08/01/2012

Provider Address

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