Individual
DR. ROGER P JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2750 CLAY EDWARDS DR STE 600, NORTH KANSAS CITY, MO 64116-3258
(816) 471-6611
(816) 471-6192
Mailing address
2750 CLAY EDWARDS DR STE 600, NORTH KANSAS CITY, MO 64116-3258
(816) 471-6611
(816) 471-6192
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
R5717
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07979011
BCBS OF KC
—
01
—
09-00221
UNITED HEALTHCARE
—
01
—
200018411
RAILROAD MEDICARE
—
01
—
4571391
AETNA
—
Enumeration date
01/04/2007
Last updated
03/07/2023
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