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1881675080
J. PHILLIP JACKSON
FORT WAYNE, IN
NPI
1881675080
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: IN 01037752A)
Enumeration Date
2005-11-07
Last Update Date
2013-02-22
Business Address
-- J. PHILLIP JACKSON M.D.
7980 W JEFFERSON BLVD
FORT WAYNE, IN 46804-4170
Phone number: 260-436-9454
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Mailing Address
-- J. PHILLIP JACKSON M.D.
3534 BROOKLYN AVE
FORT WAYNE, IN 46809-1361
Phone number: 260-747-6171
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