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Individual
RICHARD T JACKSON
Active
Individual
RICHARD T JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000729A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000089403
ANTHEM
—
05
—
100359040A
—
IN
01
—
480026551
RAILROAD MEDICARE
—
Enumeration date
05/23/2005
Last updated
11/07/2016
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