| NPI | 1912335530 |
|---|---|
| Doing Business As | JACKSON PEDIATRICS |
| Entity Type | Organization |
| Authorized Contact | TRAVIS JOHN RIDDELL Pediatrician 307-733-4627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2013-10-16 |