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Contact Information

EDWARD L JACKSON, MD
3344 N FUTRALL DR
FAYETTEVILLE, AR72703-4057
 Phone: 479-521-8200
 Fax: 479-582-7310
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pulmonary Disease

207RP1001X 11 Physician/Internal Medicine
 

Critical Care Medicine

207RC0200X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for EDWARD L JACKSON · (Male)

NPI Number 1174506448
Status Active
Credentials MD
Entity Individual
Enumeration date 11/21/2005
Last updated 03/14/2024 - About 2 years ago
Sole proprietor 1 No
Identifiers
  • AR License # E-4775
  • AR Medicaid 160768001
  • OK Medicaid 200088310A
  • AR Other 5N545 AR BCBS
  • AR Other P00327943 RR MCR
Hospital affiliation(s)
  • WASHINGTON REGIONAL MED CTR AT NORTH HILLS - (Acute Care)
    3215 N NORTH HILLS BLVD
    FAYETTEVILLE, AR 72703
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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