William Grover Jackson, M.D.
Individual provider Active NPI Gastroenterology Physician · Salisbury, MA
NPI 1003843590 · NPPES record last updated Nov 13, 2014
Key facts
- NPI
- 1003843590
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gastroenterology Physician 207RG0100X
- License
- 57551 (MA)
- Practice address
- 46 Toll Rd
Unit B
Salisbury, MA 01952-1435 - Phone
- (978) 462-3009
- Fax
- (978) 462-0177
- NPI assigned
- Jun 28, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| River Valley Infectious Disease Specialists Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 57551 | MA | |
| Gastroenterology Physician | 207RG0100X | 57551 | MA | Yes |
Addresses
Primary practice location
46 Toll Rd
Unit B
Salisbury, MA 01952-1435
Mailing address
46 Toll Rd
Unit B
Salisbury, MA 01952-1435
Phone (978) 462-3009
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3019152 | Medicaid | MA |
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All providers in Salisbury, MA · Gastroenterology Physician in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.