THOMAS MICHAEL JACKSON

CARMEN, ID
NPI1134380694
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy207P00000X Emergency Medicine
(Licence: ID  021)
Enumeration Date2008-06-18
Last Update Date2008-06-18
Business Address
Mr. THOMAS MICHAEL JACKSON DO
7 BITTERROOT ROAD
CARMEN, ID 83462
Phone number: 208-756-8047
Mailing Address
Mr. THOMAS MICHAEL JACKSON DO
7 BITTERROOT ROAD PO BOX 47
CARMEN, ID 83462
Phone number: 208-756-8047