J. PHILLIP JACKSON

FORT WAYNE, IN
NPI1881675080
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: IN  01037752A)
Enumeration Date2005-11-07
Last Update Date2013-02-22
Business Address
-- J. PHILLIP JACKSON M.D.
7980 W JEFFERSON BLVD
FORT WAYNE, IN 46804-4170
Phone number: 260-436-9454
Mailing Address
-- J. PHILLIP JACKSON M.D.
3534 BROOKLYN AVE
FORT WAYNE, IN 46809-1361
Phone number: 260-747-6171
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