LARRY A. JACKSON, MD PC


Address: 1717 Centennial Blvd, Suite 7, Springfield, OR 97477-3378
Phone: 5417260550

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 208D00000X General Practice 08513 OR Allopathic & Osteopathic Physicians

Office Location

Street Address 1717 CENTENNIAL BLVD
SUITE 7
City SPRINGFIELD
State OR
Zip Code 97477-3378

Providers in the same location

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

Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 208D00000X
Grouping Allopathic & Osteopathic Physicians
Classification General Practice

Taxonomy Definition

Definition to come...

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1861742223 Victoria J. Dow General Practice 948 Clocktower Drive, Springfield, IL 62704 2012-09-13
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
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Competitor

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City SPRINGFIELD
Zip Code 97477

Improve Information

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Dataset Information

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.

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