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Individual

GARY WAYNE JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
1804 COLLEGE AVE, LEVELLAND, TX 79336-6507
(806) 894-3141
(806) 894-7094
Mailing address
1805 S. COLLEGE AVE, LEVELLAND, TX 79336
(806) 864-3141
(806) 894-7094

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02551
TX

Other

Enumeration date
07/02/2007
Last updated
12/01/2008
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