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Dr. Kenneth Douglas Jackson, M.D.

NPI Number 1073510491

Practice Location

  • 1739 E Beverly Ave
    Kingman, AZ 86401
  • Phone: (928) 692-3456
  • Fax: (928) 692-7071

Business Location

  • 1739 E Beverly Ave
    Kingman, AZ 86401
  • Phone: (928) 692-3456
  • Fax: (928) 692-7071

Other Information

  • Enumeration date: 06/30/2005
  • Last updat date: 07/08/2007
  • NPI deactivation reason code:
  • NPI deactivation date: 01/01/1970
  • Taxonomy code: 207Q00000X
  • License number: 12522
  • License number state code: AZ
  • Primary taxonomy switch: Y

Practice Location Map

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NPI number 1073510491 is assigned to Dr. Kenneth Douglas Jackson, M.d.. Dr. Kenneth Douglas Jackson, M.d. is practice in Kingman, AZ 86401 with phone number 9286923456. The number of page view of Dr. Kenneth Douglas Jackson, M.d. is 41.

The NPI number above is maintained by the NPPES. To update the information please contact the National Plan & Provider Enumeration System.

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