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J CARVEL JACKSON D.O. NPI 1942262399


NPI Information

NPI: 1942262399
Provider Name: J CARVEL JACKSON, D.O.
Classification: Internal Medicine - 207RA0401X
Entity Type: Individual

Specialization: Addiction Medicine

PECOS Registration: Yes

Address:
303 N CENTENNIAL WAY
MESA, AZ
ZIP 85201
Phone: (480) 649-3111
Get Directions

J Carvel Jackson, D.O. is an addiction medicine internal medicine in Mesa, AZ with 36 years of experience. The provider is an internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. J Carvel Jackson, D.O. NPI is 1942262399. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: COLLEGE OF OSTEO MED OF THE PACIFIC AT POMONA
Graduation Year:1988

The provider's business location address is:

303 N CENTENNIAL WAY
MESA, AZ
ZIP 85201-733
Phone: (480) 649-3111
Fax: (480) 649-3113

The NPI 1942262399 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 4/3/2006 and was last updated on 2/2/2023.


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
1207RA0401XInternal MedicineAddiction Medicine2543ARIZONAYes
2208100000XPhysical Medicine & Rehabilitation2543ARIZONANo

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
1111328MEDICAIDARIZONA

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: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.