Provider Demographics
NPI:1578898771
Name:JACKSON, SARAH COOPER (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:COOPER
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ROBIN
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-222-7337
Mailing Address - Fax:515-222-7340
Practice Address - Street 1:1601 NW 114TH ST STE 345
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7036
Practice Address - Country:US
Practice Address - Phone:515-222-7337
Practice Address - Fax:515-222-7340
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR71110208000000X
IAMD-39615208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics