Timothy Lawrence Jackson, PA Valid NPI

Individual provider · Medical Physician Assistant · Williams, AZ

NPI

1124338504

Type

Individual (Type 1)

Primary specialty

Medical Physician Assistant (Physician Assistant)

Specialty group

Physician Assistants & Advanced Practice Nursing Providers

Taxonomy code

363AM0700X

License number

5407 (AZ)

Sex

Male

Sole proprietor

Yes

Enumerated

2010-10-19

Last updated

2021-07-21