Organization
R BRENT JACKSON DO PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
R BRENT JACKSON DO (OWNER)
(210) 494-9600
Entity
Organization
Contact information
Practice address
155 E SONTERRA BLVD, SUITE 211, SAN ANTONIO, TX 78258-3987
(210) 494-9600
(210) 494-9601
Mailing address
PO BOX 593377, SAN ANTONIO, TX 78259-0218
(210) 494-9600
(210) 494-9601
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
Other
Enumeration date
08/05/2014
Last updated
04/12/2017
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