Provider Demographics
NPI:1164421673
Name:JACKSON, FRANK WILSON III (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:WILSON
Last Name:JACKSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:423 N 21ST ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2207
Mailing Address - Country:US
Mailing Address - Phone:717-761-0930
Mailing Address - Fax:717-761-0465
Practice Address - Street 1:423 N 21ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2207
Practice Address - Country:US
Practice Address - Phone:717-761-0930
Practice Address - Fax:717-761-0465
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055416L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01024101OtherCAPITAL BLUE CROSS
PA0016834680003Medicaid
PA5333615OtherAETNA US HEALTHCARE
PAG84061OtherHEALTHAMERICA
PA527552OtherHIGHMARK BLUE SHIELD
PA100012586OtherRAILROAD MEDICARE