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Organization
LAKE GRANBURY INTERNAL MEDICINE & PEDIATRICS, PA
Active
Organization
LAKE GRANBURY INTERNAL MEDICINE & PEDIATRICS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PENELOPE A. JACKSON M.D. (PHYSICIAN/OWNER)
(817) 579-1005
Entity
Organization
Contact information
Practice address
2005 ROCKVIEW DRIVE, GRANBURY, TX 76049
(817) 579-1005
(817) 579-1093
Mailing address
2005 ROCKVIEW DRIVE, GRANBURY, TX 76049
(817) 579-1005
(817) 579-1093
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
09/14/2006
Last updated
04/02/2014
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