EDGAR BASIL JACKSON

MILWAUKEE, WI
NPI1598833410
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy2084P0800X Psychiatry & Neurology, Psychiatry
(Licence: WI  13939-20)
Additional Taxonomies2084A0401X Psychiatry & Neurology, Addiction Medicine
(Licence: WI  AJ8930984 XJ8930984)
Enumeration Date2006-11-30
Last Update Date2024-07-03
Business Address
Dr. EDGAR BASIL JACKSON MD
1225 W MITCHELL ST 223
MILWAUKEE, WI 53204-3383
Phone number: 414-383-4455
Mailing Address
Dr. EDGAR BASIL JACKSON MD
1225 W MITCHELL ST 223
MILWAUKEE, WI 53204-3383
Phone number: 414-383-4455