Individual
KENNETH C JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7301 N COMANCHE AVE, OU PHYSICIANS, WARR ACRES, OK 73132-6646
(405) 721-8090
(405) 722-8529
Mailing address
7301 N COMANCHE AVE, WARR ACRES, OK 73132-6646
(405) 721-8090
(405) 722-8529
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
11030
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11030
LICENSE
OK
Enumeration date
02/06/2007
Last updated
03/07/2023
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