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Individual

DR. RICHARD JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
505 REGENCY XING, SOUTHLAKE, TX 76092-9501
(817) 913-6144
Mailing address
505 REGENCY XING, SOUTHLAKE, TX 76092-9501
(817) 913-6144

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
K8228
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
8G7458
BCBS THRU HEB
TX
01
P00374822
RAILROAD MCARE THRU HEB
TX
Enumeration date
05/30/2006
Last updated
01/17/2008
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