Leslie Jackson, MD

NPI #1386821502 in Taylorville, Illinois

Provider Information

NPI Number: 1386821502
Entity Type: Organization
Organization Name: Leslie Jackson, MD
Primary Specialty: Family Medicine
Enumeration Date: Jan 30, 2008
Last Updated: Jun 24, 2008

Practice Location

Address: 115 E PLEASANT ST
City: Taylorville
State: Illinois
ZIP Code: 62568-1560
Phone: (217) 824-3757

Authorized Official

Name: DR. LESLIE JACKSON, MD
Title: PRESIDENT
Phone: (217) 824-3757

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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