Individual
DR. ROBERTA L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
842 E MAIN ST, MEDFORD, OR 97504-7134
(541) 773-2493
(541) 779-3027
Mailing address
842 E MAIN ST, MEDFORD, OR 97504-7134
(541) 773-2493
(541) 779-3027
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD15832
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
055814
—
OR
Enumeration date
04/06/2006
Last updated
12/08/2014
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