Individual
VALERIE P JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
714 N SENATE AVE, STE 100, INDIANAPOLIS, IN 46202-3763
(317) 715-6402
(317) 715-6415
Mailing address
714 N SENATE AVE, STE 100, INDIANAPOLIS, IN 46202-3763
(317) 715-6402
(317) 715-6415
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01028136
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100358070
—
IN
Enumeration date
06/12/2006
Last updated
06/13/2011
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