Individual
DR. JEFFREY A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
409 W FERGUSON ST, TYLER, TX 75702-5632
(903) 596-8353
Mailing address
409 W FERGUSON ST, TYLER, TX 75702-5632
(903) 596-8353
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
4301045865
MI
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
G8711
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1010571-01
CSHCN
TX
05
—
1010571-02
—
TX
05
—
201350760
—
IN
01
—
460002994
RR/MEDICARE
TX
01
—
807573
BLUE SHIELD
TX
Enumeration date
03/27/2006
Last updated
11/19/2021
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