Individual
JOHN CLAUDE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
410 E CHEROKEE ST, WAGONER, OK 74467-4708
(918) 485-5591
(918) 485-5758
Mailing address
410 E CHEROKEE ST, WAGONER, OK 74467-4708
(918) 485-5591
(918) 485-5758
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1672
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100141080C
—
OK
05
—
100141080E
—
OK
Enumeration date
03/30/2006
Last updated
03/23/2017
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