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NPI Verification

National Provider Identifier: 1184740045

Robert Elvon Jackson, MD

Individual Provider

Credentials

Primary Specialty

Urology

Code: 208800000X

All Specialties (3)

Student in an Organized Health Care Education/Training Program

Code: 390200000X

Urology

Code: 208800000X

Urology

Code: 208800000X

Primary

Practice Address

875 S VANGUARD WAY

SUITE 200 D

MERIDIAN, ID 83642

Phone: 208-782-6730

NPI Enumeration Date

March 22, 2007

NPI Number

1184740045

Data sourced from the official CMS NPPES Registry. This information is provided by the Centers for Medicare & Medicaid Services and is updated regularly.

View on CMS NPPES Registry