Organization
INGRID W JACKSON MD INC. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. INGRID WORRELL JACKSON M.D. (OWNER/PRESIDENT)
(405) 473-7927
Entity
Organization
Contact information
Practice address
13321 N MERIDIAN AVE, STE 314, OKLAHOMA CITY, OK 73120-8356
(405) 470-7189
(405) 470-7712
Mailing address
6957 NW EXPRESSWAY # 254, OKLAHOMA CITY, OK 73132-3533
(405) 473-7927
(405) 470-7712
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15786
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100220060B
—
OK
Enumeration date
05/26/2009
Last updated
05/26/2009
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