Organization
HORACE J JACKSON MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HORACE J JACKSON MD (PRESIDENT OWNER)
(804) 788-0556
Entity
Organization
Contact information
Practice address
505 W LEIGH STREET, SUITE 207, RICHMOND, VA 23220
(804) 788-0556
(804) 788-1141
Mailing address
505 W LEIGH STREET, SUITE 207, RICHMOND, VA 23220
(804) 788-0556
(804) 788-1141
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006954
ANTHEM BS
VA
05
—
006O49656
—
VA
Enumeration date
07/09/2006
Last updated
06/24/2008
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