Provider Demographics
NPI:1467497461
Name:JACKSON, BRIAN D (MD)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:D
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 HARMONY PARK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913
Mailing Address - Country:US
Mailing Address - Phone:501-623-1311
Mailing Address - Fax:501-321-1214
Practice Address - Street 1:151 HARMONY PARK CIRCLE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:501-623-1311
Practice Address - Fax:501-321-1214
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8504207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123996001Medicaid
AR5J211Medicare ID - Type Unspecified