MEDICARE: JEFFREY ALLEN JACKSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	F5585	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01031010	OTHER	TX	RR MEDICARE
2	P00866614	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	1821090697	OTHER	TX	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821090697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY ALLEN JACKSON M.D.

Provider Business Mailing Address
First Line	:	13828 DRAKEWOOD DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77498-2662
Country	:	US
Telephone Number	:	713-705-6972
Fax Number	:	281-494-6410

Provider Business Practice Location Address
First Line	:	13828 DRAKEWOOD DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77498-2662
Country	:	US
Telephone Number	:	713-705-6972
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	04/04/2022

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