DR. KEVIN GORDON JACKSON M.D. NPI 1225032782

NPI Information

NPI: 1225032782
Provider Name: DR. KEVIN GORDON JACKSON, M.D.
Classification: Family Medicine - 207QG0300X
Specialization: Geriatric Medicine
Entity Type: Individual
PECOS Registration: Yes
Address: 7600 N 16TH ST STE 112
PHOENIX, AZ
ZIP 85020
Phone: (602) 830-0605

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NPI Details

DR. Kevin Gordon Jackson, M.D. is a geriatric medicine family medicine in Phoenix, AZ. The provider is a family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. DR. Kevin Gordon Jackson, M.D. NPI is 1225032782. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

7600 N 16TH ST STE 112
PHOENIX, AZ
ZIP 85020-446
Phone: (602) 830-0605

The NPI 1225032782 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/11/2005 and was last updated on 4/13/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207QG0300X	Family Medicine	Geriatric Medicine	22105	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	428525	MEDICAID	ARIZONA
2	AZ0728320	OTHER	ARIZONA	BLUE CROSS OF ARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

NPI Synchronization or Removal

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