David A. Jackson, M.D.
Individual provider Active NPI Internal Medicine Physician · Pinon, AZ
NPI 1508000480 · NPPES record last updated Jan 8, 2014
Key facts
- NPI
- 1508000480
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 35.099840 (OH)
- Practice address
- Navajo Route 4
Pinon Health Center
Pinon, AZ 86510 - Phone
- (928) 725-9500
- NPI assigned
- Apr 23, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35.099840 | OH | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phillip Tutnauer DPM | Past |
Accepting new patients | |
| DHHS PHS Naihs Chinle Comprehensive Health Care Facility | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 35.099840 | OH | Yes |
| Pediatrics Physician | 208000000X | 35.099840 | OH |
Addresses
Primary practice location
Navajo Route 4
Pinon Health Center
Pinon, AZ 86510
Mailing address
PO Box 10
Pinon, AZ 86510-0010
Phone (928) 725-9500
Other providers in Pinon, AZ
- Cynthia Louise Grubbs
- Alice F. Hatch
- Jane Heavilin
- Lauren Kelli Houston
- Madelene Howard
- Michelley Jackson
- Laverne James
- Daniel R Johnson
- Karen Frieda Kilman
- Megan S Klingler
All providers in Pinon, AZ · Internal Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 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.