Individual
DR. ANTHONY D JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1140 SW 44TH ST, OKLAHOMA CITY, OK 73109-3602
(405) 632-1730
(405) 632-2640
Mailing address
1140 SW 44TH ST, OKLAHOMA CITY, OK 73109-3602
(405) 632-1730
(405) 632-2640
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
20399
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100131710A
—
OK
Enumeration date
05/16/2006
Last updated
06/18/2008
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