Individual
DR. DOROTHY LOUISE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1114 W BOW ST, TYLER, TX 75702-5137
(903) 595-5595
(903) 595-5985
Mailing address
1114 W BOW ST, TYLER, TX 75702-5137
(903) 595-5595
(903) 595-5985
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
N1355
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199916104
—
TX
Enumeration date
02/09/2006
Last updated
03/20/2015
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