Individual
ANDREW A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9180 PINECROFT DR STE 600, SHENANDOAH, TX 77380
(281) 296-0365
(281) 298-8907
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 234-0813
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Q0464
TX
207RH0003X
Hematology & Oncology Physician
Primary
Q0464
TX
207RX0202X
Medical Oncology Physician
Q0464
TX
390200000X
Student in an Organized Health Care Education/Training Program
BP1-0040195
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
335913503
—
TX
Enumeration date
08/01/2012
Last updated
10/04/2023
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