Organization
EAR INSTITUTE OF TEXAS P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LANCE E JACKSON MD (OWNER)
(210) 696-4327
Entity
Organization
Contact information
Practice address
18518 HARDY OAK BLVD, SUITE 300, SAN ANTONIO, TX 78258-4271
(210) 696-4327
(210) 798-2509
Mailing address
18518 HARDY OAK BLVD, SUITE 300, SAN ANTONIO, TX 78258-4271
(210) 696-4327
(210) 798-2509
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
L5777
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0036JV
BLUE SHIELD
TX
05
—
157517701
—
TX
01
—
P00019999
MEDICARE RAILROAD
TX
Enumeration date
03/08/2007
Last updated
02/27/2012
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