Individual
HORACE J JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
505 W LEIGH STREET, SUITE 207, RICHMOND, VA 23220
(804) 788-0556
(804) 788-1141
Mailing address
505 W LEIGH STREET, SUITE 207, RICHMOND, VA 23220
(804) 788-0556
(804) 788-1141
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
0101035670
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006049656
—
VA
01
—
006954
ANTHEM BS
VA
Enumeration date
07/12/2006
Last updated
08/29/2007
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