Individual
DR. MICHAEL S JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
620 S MADISON ST STE 304, ENID, OK 73701-7270
(580) 233-6350
(580) 233-6106
Mailing address
5300 N INDEPENDENCE AVE, 280, OKLAHOMA CITY, OK 73112-5556
(580) 233-6350
(580) 233-6106
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
04-28958
KS
207V00000X
Obstetrics & Gynecology Physician
Primary
30290
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100387680A
—
KS
05
—
100387680H
—
KS
Enumeration date
07/03/2006
Last updated
09/09/2020
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