Organization
WILFORD HALL USAF MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARLON B JACKSON (CREDENTIALS MANAGER)
(210) 292-6707
Entity
Organization
Contact information
Practice address
2200 BERGQUIST DR, LACKLAND A F B, TX 78236-9907
(210) 292-7361
Mailing address
116 TRILLIUM LN, SAN ANTONIO, TX 78213-2513
(210) 342-6789
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
F2298
TX
Other
Enumeration date
12/01/2006
Last updated
08/22/2020
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