Individual
JIMMIE K JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1237 GLENBROOK DR, OKLAHOMA CITY, OK 73118-1021
(405) 659-7578
(405) 232-3767
Mailing address
1237 GLENBROOK DR, OKLAHOMA CITY, OK 73118-1021
(405) 659-7578
(405) 232-3767
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
8567
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100087430A
—
OK
Enumeration date
02/23/2006
Last updated
04/10/2017
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