Alfred Vaughn D Jackson (NPI# 1891746707, PAC ID# 4789641168) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1891746707 |
| PAC ID by PECOS | 4789641168 |
| Professional Enrollment ID | I20041216001128 |
| Full Name | Alfred Vaughn D Jackson |
| Address |
416 Main St La Jara CO 81140-0272 |
| Gender | M |
| Credential | MD |
| Graduation Year | 1987 |
| Primary Specialty | FAMILY MEDICINE |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 060008 | SAN LUIS VALLEY HEALTH |
| 061308 | SAN LUIS VALLEY HEALTH CONEJOS COUNTY HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 416 Main St, La Jara, CO 81140-0272 |
| Street Address |
416 MAIN ST |
| City | LA JARA |
| State | CO |
| Zip | 81140-0272 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Michael S Horney | Chiropractic | 416 Main St, 25a, Setauket, NY 11733-3841 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Angela Nicole Daugherty | Nurse Practitioner | Lutheran Hospital Association of The San Luis Valley | 19021 Us Hwy 285, La Jara, CO 81140-9410 |
| James E Walker | Family Practice | Lutheran Hospital Association of The San Luis Valley | 19021 Us Hwy 285, La Jara, CO 81140-9410 |
| Linda E Doyle-limmer | Nurse Practitioner | Lutheran Hospital Association of The San Luis Valley | 19021 Us Hwy 285, La Jara, CO 81140-9410 |
| Ellen W Call | Nurse Practitioner | Lutheran Hospital Association of The San Luis Valley | 19021 Us Hwy 285, La Jara, CO 81140-9410 |
| City | LA JARA |
| Zip Code | 81140 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | LA JARA + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Alfred Vaughn D Jackson.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.