Individual
THERESA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4629 E 13TH PL, TULSA, OK 74112-6103
(405) 822-8297
Mailing address
4629 E 13TH PL, TULSA, OK 74112-6103
(405) 822-8297
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
32423
OK
208600000X
Surgery Physician
BP10052439
TX
Other
Enumeration date
04/08/2015
Last updated
07/11/2024
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