# SAMANTHA JACKSON MD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SAMANTHA L JACKSON MD
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1275973646
- **Legal business name:** SAMANTHA L JACKSON MD
- **Authorized official:** SAMANTHA L JACKSON M.D. (OWNER)
- **Authorized official phone:** (580) 726-2226

## Contact information

- **Practice address:** 415 W FOREST LN, HOBART, OK 73651-1645
- **Practice address phone:** (580) 726-2226
- **Practice address fax:** (580) 726-8425
- **Mailing address:** 415 W FOREST LN, HOBART, OK 73651-1645
- **Mailing address phone:** (580) 726-2226
- **Mailing address fax:** (580) 726-8425

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 19876 | OK | Yes |

## Other

- **Enumeration date:** 07/01/2013
- **Last updated:** 01/16/2017