Individual
DR. RICHARD WAYNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6920 GATWICK DR, STE 200, INDIANAPOLIS, IN 46241-9504
(317) 455-1064
(317) 455-1204
Mailing address
6920 GATWICK DR, STE 200, INDIANAPOLIS, IN 46241-9504
(317) 455-1064
(317) 455-1204
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
01028135
IN
Other
Enumeration date
06/21/2005
Last updated
03/10/2016
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