ID CONSULTS AND SERVICES, PA
Osteopathic Medicine at Northside Dr, Key West, FL

License number
Florida ME114239
Category
Osteopathic Medicine
Type
Internal Medicine
License number
Florida ME114239
Category
Osteopathic Medicine
Type
Infectious Disease
Owner
Name: DR. JERRY JACKSON MD
Title: PRESIDENT
Phone: (305) 615-3300
Address
Address
3142 Northside Dr STE 101, Key West, FL 33040
National Provider ID: 1215353677
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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ID CONSULTS AND SERVICES, PA

Key West, FL

Registration:
Oct 12, 2012
Addresses:
3142 Northside Dr STE 101, Key West, FL 33040 (Physical)
513 Olivia St, Key West, FL 33040 (Mailing)
State ID:
P12000086542
Business type:
Florida Profit Corporation
Jerry Jackson, 513 Olivia St, Key West, FL 33040 (Physical)
Agent:
Carla Wester,10151 Deerwood Park Blvd, Jacksonville, FL 32256 (Physical)
FEI/EIN:
46-1291439

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