Active NPI
Donald Jackson Jr., MD
- Occupational Medicine Physician
- Detroit, MI
National Provider Identifier
1700200086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Medicine Physician
- License
- 43010441496
- Practice address
- 2500 E Grand Blvd
Medical Dept
Detroit, MI 48211-2006 - Phone
- (313) 972-6202
- Fax
- (313) 972-6094
- NPI assigned
- Feb 7, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Medicine Physician | 2083X0100X | 43010441496 | MI | Primary |
Addresses
Primary practice location
2500 E Grand Blvd
Medical Dept
Detroit, MI 48211-2006
Mailing address
2500 E Grand Blvd
Medical Dept
Detroit, MI 48211-2006
Phone (313) 972-6202
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43010441496 | MI | MD | Occupational Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391731200000",
"number": "1700200086",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 E GRAND BLVD",
"address_2": "MEDICAL DEPT",
"city": "DETROIT",
"state": "MI",
"postal_code": "482112006",
"telephone_number": "313-972-6202",
"fax_number": "313-972-6094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 E GRAND BLVD",
"address_2": "MEDICAL DEPT",
"city": "DETROIT",
"state": "MI",
"postal_code": "482112006",
"telephone_number": "313-972-6202",
"fax_number": "313-972-6094"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DONALD",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-02-07",
"last_updated": "2014-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "2083X0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Occupational Medicine",
"state": "MI",
"license": "43010441496",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.