Individual
ELISABETH VENNECIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2222 WELBORN ST, TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN, DALLAS, TX 75219-3924
(214) 559-7817
Mailing address
2222 WELBORN ST, TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN, DALLAS, TX 75219-3924
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
J7527
TX
Other
Enumeration date
03/31/2014
Last updated
03/31/2014
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