Individual
DR. WALTER OSBORNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10329 GREENOAK BLVD, FORT WAYNE, IN 46814-9546
(260) 616-0681
(866) 513-3371
Mailing address
10329 GREENOAK BLVD, FORT WAYNE, IN 46814-9546
(260) 616-0681
(866) 513-3371
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01067150A
IN
207P00000X
Emergency Medicine Physician
23797
SC
207P00000X
Emergency Medicine Physician
48786
GA
207P00000X
Emergency Medicine Physician
7739
ND
207P00000X
Emergency Medicine Physician
A070415
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G48786
—
SC
Enumeration date
10/27/2006
Last updated
06/05/2013
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