Individual
ROBERT JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 358-0000
Mailing address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 358-4000
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
Q9385
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
398453601
—
TX
Enumeration date
05/09/2014
Last updated
07/19/2019
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