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1811979123
DEREK C JACKSON
ORLANDO, FL
NPI
1811979123
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: FL PA9101356)
Enumeration Date
2005-11-14
Last Update Date
2007-07-08
Business Address
-- DEREK C JACKSON PA
601 E ROLLINS ST
ORLANDO, FL 32803-1248
Phone number: 407-303-5600
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Mailing Address
-- DEREK C JACKSON PA
500 WINDERLEY PL SUITE 115
MAITLAND, FL 32751-7247
Phone number: 407-875-8784
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