LARRY A. JACKSON, MD PC (NPI# 1134565849) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1134565849 |
Entity Type | Organization |
Organization Name | LARRY A. JACKSON, MD PC |
Practice Address |
1717 Centennial Blvd Suite 7 Springfield OR 97477-3378 |
Practice Telephone | 5417260550 |
Practice Fax Number | 5417267485 |
Mailing Telephone | 5417260550 |
Mailing Fax Number | 5417267485 |
Enumeration Date | 2013-05-21 |
Last Update Date | 2013-05-21 |
Authorized Official Name | DR. LARRY ARTHUR JACKSON (PRESIDENT) |
Authorized Official Telephone | 5417260550 |
Authorized Official Credential | MD |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 208D00000X | General Practice | 08513 | OR | Allopathic & Osteopathic Physicians |
Street Address |
1717 CENTENNIAL BLVD SUITE 7 |
City | SPRINGFIELD |
State | OR |
Zip Code | 97477-3378 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1487670451 | Richard F Erpelding | Family Medicine | 1717 Centennial Blvd, #7, Springfield, OR 97477 | 2006-07-14 |
1710013453 | Christopher Andrew Park | Occupational Therapist | 1717 Centennial Blvd, Suite 6, Springfield, OR 97477-3378 | 2007-02-26 |
1508970898 | Complete Vision Center, P.C. | Optometrist | 1717 Centennial Blvd, Suite 2, Springfield, OR 97477-3378 | 2006-08-17 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1508416140 | Chase Michael Collings | Physician Assistant | 960 N 16th St Ste 303, Springfield, OR 97477 | 2019-09-16 |
1174079396 | Amie Flanagan | Occupational Therapy Assistant | 3152 Valentine Court, Springfield, OR 97477 | 2016-08-28 |
1609229590 | Kiernan Davis Snedigar | Counselor | 175 W B St Ste J, Springfield, OR 97477 | 2016-07-15 |
1578914206 | Ryan James Dixon | Counselor | 1923 Centennial Blvd, Springfield, OR 97477 | 2016-06-23 |
1902275464 | Jovonnie Bashaw | Counselor | 1157 5th St, Springfield, OR 97477 | 2015-09-15 |
1053759506 | Norco Inc | Durable Medical Equipment & Medical Supplies | 302 Shelley St Ste 7&8, Springfield, OR 97477 | 2013-06-06 |
1780931634 | Justin Morris | Pharmacist | 1891 Pioneer Parkway East, Springfield, OR 97477 | 2012-08-09 |
1194083105 | Mersedeh Bahr Hosseini | Psychiatry & Neurology | 3311 Riverbend Dr., Neurohospitalists, Springfield, OR 97477 | 2012-04-26 |
1962769679 | Hiro Kawata | Internal Medicine | 3311 Rierbend Dr., Springfield, OR 97477 | 2012-04-19 |
1659662823 | Wendy A Teigen | Counselor | 3995 Marcola Rd., Springfield, OR 97477 | 2011-04-22 |
Find all providers in zip 97477 |
Taxonomy Code | 208D00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | General Practice |
Definition to come... |
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1386963429 | Care Station Medical Group, Pa | General Practice | 90 Us Highway 22, Springfield, NJ 07081-3110 | 2010-05-28 |
1164758892 | John Thomas Kelly | General Practice | 2105 Interlacken Dr, Springfield, IL 62704 | 2009-10-31 |
1972747574 | Bradley Bradshaw | General Practice | 1904 S Shady Hill Ln, Springfield, MO 65809-2601 | 2009-04-27 |
1265685515 | International Medical Center, Inc | General Practice | 5410 Port Royal Rd, Suite 100, Springfield, VA 22151-2314 | 2008-10-30 |
1518121565 | Robert Charles Woods | General Practice | 1522 S Cedar Ridge St, Springfield, MO 65809-2356 | 2008-07-17 |
1083817639 | Saul Wider | General Practice | 359 Spring Valley Rd, Springfield, PA 19064 | 2007-06-08 |
1669681938 | Shwee-tian Chou | General Practice | 517 Boston Rd, Springfield, MA 01109-1230 | 2007-05-22 |
1326116229 | Abdulkareem I Kraidy | General Practice | 6801 Backlick Rd, Springfield, VA 22150-3071 | 2006-12-01 |
Find all providers in SPRINGFIELD |
City | SPRINGFIELD |
Zip Code | 97477 |
Please comment or provide details below to improve the information on LARRY A. JACKSON, MD PC.
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.