Provider Demographics
NPI:1902866379
Name:ILIFF, W. JACKSON (MD)
Entity Type:Individual
Prefix:DR
First Name:W.
Middle Name:JACKSON
Last Name:ILIFF
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 1:4 W ROLLING CROSSROADS
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6280
Mailing Address - Country:US
Mailing Address - Phone:410-869-1990
Mailing Address - Fax:410-869-1992
Practice Address - Street 1:4 W ROLLING CROSSROADS
Practice Address - Street 2:SUITE 7
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6280
Practice Address - Country:US
Practice Address - Phone:410-869-1990
Practice Address - Fax:410-869-1992
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0008485207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology