Jackson, Jeffrey A

Jackson, Jeffrey A is an individual health care provider with primary practice located at 409 W Ferguson St , Tyler TX 75702-5632. He recently has only one registered license in Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism, which is considered as his primary health care specialty. Jackson, Jeffrey A can be contacted via phone (903) 596-8353.

Contact Information

Primary practice address
409 W Ferguson St Tyler TX 75702-5632
Phone: (903) 596-8353
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X 4301045865 Michigan
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X G8711 Texas

Profile Details

NPI number 1972563443
LBN Legal business name Jackson, Jeffrey A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 27th, 2006
Last updated Nov 19th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972563443 NPPES
Texas Other 460002994 RR/MEDICARE
Texas MEDICAID 1010571-02 RR/MEDICARE
Texas MEDICAID 201350760 RR/MEDICARE
Texas Other 1010571-01 RR/MEDICARE
Texas Other 807573 RR/MEDICARE

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