ROBERT ELVON JACKSON MD
Individual Provider (NPI-1)
Active
Urology
Provider Information
- NPI Number
1184740045- Provider Type
- Individual Provider (NPI-1)
- Credentials
- MD
- Status
- Active
Contact & Location
- Address
- 875 S VANGUARD WAY SUITE 200 D, MERIDIAN, ID, 83642
- Phone
- (208) 782-6730
- Fax
- (208) 759-7822
Specialties & Taxonomies
Student in an Organized Health Care Education/Training Program
License: MI #4301087650
Urology
License: MI #4301087650
Urology
Primary License: ID #M-11868