Individual
DR. JOHN S JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6445 HARRIS PKWY, STE. 100, FORT WORTH, TX 76132-4138
(817) 361-6900
(817) 263-2918
Mailing address
6445 HARRIS PKWY, STE. 100, FORT WORTH, TX 76132-4138
(817) 361-6900
(817) 263-2918
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
E1626
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4035105
AETNA
—
01
—
85Y011
BCBS
—
Enumeration date
11/04/2005
Last updated
07/08/2007
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