Individual
RICHARD J JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1901 SW H K DODGEN LOOP, TEMPLE, TX 76502-3500
(254) 935-4000
(254) 935-4111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
N-8271
AR
2086S0120X
Pediatric Surgery Physician
Primary
N3094
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121627001
—
AR
05
—
125912907
—
TX
05
—
125912908
—
TX
05
—
137345810
—
TX
05
—
140442852
—
TX
Enumeration date
10/13/2006
Last updated
06/08/2021
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