Individual
DR. THOMAS L JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2450 N PARK DR, COLUMBUS, IN 47203-2216
(812) 376-8997
(812) 373-5323
Mailing address
2450 N PARK DR, COLUMBUS, IN 47203-2292
(812) 376-8997
(812) 373-5323
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01046379A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01046379A
STATE LICENSE NUMBER
IN
05
—
200134430B
—
IN
Enumeration date
12/22/2005
Last updated
08/02/2010
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