DR. MARK L JACKSON (NPI# 1114956562) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114956562 |
| Entity Type | Individual |
| Full Name | DR. MARK L JACKSON |
| Credential | M.D. |
| Practice Address |
11209 N Tatum Blvd Suite 110 Phoenix AZ 85028-3091 |
| Mailing Address |
Po Box 14687 Scottsdale AZ 85267-4687 |
| Practice Telephone | 6022488002 |
| Practice Fax Number | 6022488399 |
| Mailing Telephone | 4809918100 |
| Mailing Fax Number | 4809921028 |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
15432 | AZ | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134755721 | Mark Wayne Jackson | Occupational Therapist | 8608 Marys Creek Dr, Benbrook, TX 76116-7624 | 2020-03-16 |
| 1811409535 | Mark Jackson | Driver | 26048 Pine Tree Rd, Rhoadesville, VA 22542-8549 | 2017-11-03 |
| 1932488194 | Mark Monroe Jackson | Social Worker | 119 Kona Dr, Galveston, TX 77554-8623 | 2011-08-05 |
| 1477860757 | Mark Allan Jackson | Technician, Other | 322 S Jefferson St, Louisa, KY 41230-1316 | 2010-09-08 |
| 1063620516 | Mark Kent Jackson | Pharmacist | 605 Hwy 31 South, Suite D, Athens, AL 35611 | 2007-05-18 |
| 1528289881 | Mark Jackson | Preventive Medicine | 10 Standing Rock Agency Avenue, Fort Yates, ND 58538 | 2007-05-02 |
| 1255470209 | Mark F Jackson | Anesthesiology | 3930 Us 1 S, Saint Augustine, FL 32086-7089 | 2007-02-06 |
| 1598788796 | Mark K Jackson | Dentist | 7007 Old Sauk Road, Madison, WI 53717 | 2006-07-26 |
| 1003877077 | Mark R. Jackson | Emergency Medicine | 1474 E Erda Way, Tooele, UT 84074-9737 | 2006-03-30 |
| 1073585238 | Mark A Jackson | Family Medicine | 1000 Pavilions Circle, Mark A Jackson Md Plc, Traverse City, MI 49684 | 2006-02-02 |
| Street Address |
11209 N TATUM BLVD SUITE 110 |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85028-3091 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124011713 | Thomas W Bauch | Family Medicine | 11209 N Tatum Blvd, 175, Phoenix, AZ 85028-3091 | 2005-08-29 |
| 1750837050 | Jennifer Billiard | Social Worker | 11209 N Tatum Blvd, #260, Phoenix, AZ 85028-6025 | 2016-08-28 |
| 1063861060 | Matthew Wisehart | Physical Therapist | 11209 N Tatum Blvd, Ste B-120, Phoenix, AZ 85028-3091 | 2016-06-09 |
| 1861862989 | Jennifer Anne Billingsley | Nurse Practitioner | 11209 N Tatum Blvd, Suite 255, Phoenix, AZ 85028 | 2015-10-01 |
| 1467876524 | Melisa Ann Curry | Physical Therapist | 11209 N Tatum Blvd, Ste B-120, Phoenix, AZ 85028-3091 | 2014-02-10 |
| 1114267887 | Allison M Gaylor | Nurse Practitioner | 11209 N Tatum Blvd, Suite 180, Phoenix, AZ 85028-3091 | 2013-02-18 |
| 1598011785 | Jessica Lynn Giddings | Nurse Practitioner | 11209 N Tatum Blvd, Suite 260, Phoenix, AZ 85028-3091 | 2012-07-25 |
| 1518119692 | Joanne L Schlesinger | Nurse Practitioner | 11209 N Tatum Blvd, Suite 260, Phoenix, AZ 85028-3091 | 2008-10-21 |
| 1295984987 | Sonya A Bladow | Chiropractor | 11209 N Tatum Blvd, Ste 140, Phoenix, AZ 85028-3091 | 2008-09-17 |
| 1114182888 | Rakesh Kumar Bagai | Internal Medicine | 11209 N Tatum Blvd, #260, Phoenix, AZ 85028-3091 | 2008-07-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235626565 | Celice Korsten | Psychologist | 11020 N. Tatum Blvd., Ste. 100, Phoenix, AZ 85028 | 2018-04-23 |
| 1720591605 | Michele Kaplan | Counselor | 11640 N Tatum Blvd #3096, Phoenix, AZ 85028 | 2017-11-14 |
| 1154840304 | Faustino M. Gonzalez, Md PC | Anesthesiology | 11811 N. Tatum Blvd, Suite 3031, Phoenix, AZ 85028 | 2017-09-19 |
| 1679092514 | Savior Palliative Care LLC | Family Medicine | 4530 E Shea Blvd Ste 175, Phoenix, AZ 85028 | 2017-09-12 |
| 1437688892 | Harmony Behavioral Health | Behavioral Analyst | 3008 E Sierra St, Phoenix, AZ 85028 | 2017-06-08 |
| 1275949224 | Alexander D Garza | Podiatrist | 3101 E Shea Blvd Ste 220, Phoenix, AZ 85028 | 2014-07-09 |
| 1720418379 | Alyssa Hale | Occupational Therapy Assistant | 4600 East Shea Boulevard, Suite 101, Phoenix, AZ 85028 | 2013-11-19 |
| 1932534476 | Stephen Howard Garber | Otolaryngology | 9607 N. 43rd Way, Phoenix, AZ 85028 | 2013-09-03 |
| 1366798050 | Irna Lynn Shamos | Clinical Neuropsychologist | 4516 East Onyx Avenue, Arizona Psychological Diagnostics, Plc, Phoenix, AZ 85028 | 2012-07-31 |
| 1285930925 | Cathy Ann Payne | Nurse Practitioner | 11209 N Tatum Blvd Ste 260, Phoenix, AZ 85028 | 2011-01-27 |
| Find all providers in zip 85028 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598243867 | Mdig of Florida, LLC | Radiology | 10835 N 25th Ave Ste 140, Phoenix, AZ 85029-3408 | 2018-07-30 |
| 1265974836 | Teleradiology Specialists LLC | Radiology | 4813 E Piccadilly Rd, Phoenix, AZ 85018-5540 | 2016-11-13 |
| 1447630140 | Mohamad Nass | Radiology | 34718 N 24th Ave, Phoenix, AZ 85086-6605 | 2015-06-08 |
| 1659703304 | Tesla Imaging and Medical | Radiology | 43817 Nth 50th Dr, Phoenix, AZ 85087 | 2013-08-05 |
| 1962748574 | Alysha Keren Vartevan | Radiology | 4130 E Van Buren St Ste 100, Phoenix, AZ 85008-6996 | 2012-12-31 |
| 1003177767 | Donald A Tobias | Radiology | 97 Biltmore Est, Phoenix, AZ 85016-2820 | 2012-05-30 |
| 1518279660 | Nicholas Bhojwani | Radiology | 2625 East Camelback Road, Unit 261, Phoenix, AZ 85016 | 2010-07-06 |
| 1437471323 | Smi Imaging, LLC | Radiology | 13838 S 46th Pl Ste 200, Phoenix, AZ 85044-7803 | 2010-02-19 |
| 1891928107 | Smi Imaging, LLC | Radiology | 20414 N 27th Ave Ste 150, Phoenix, AZ 85027-3246 | 2009-09-02 |
| 1396978250 | North Mountain Imaging Specialists, LLC | Radiology | 2500 N. Utopia Road, Suite 100, Phoenix, AZ 85027 | 2009-08-26 |
| Find all providers in PHOENIX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.