Healthcare Provider Details

I. General information

NPI: 1922150663
Provider Name (Legal Business Name): J. DON JACKSON JR, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WILLOW CREEK PKWY SUITE 200 A
PALESTINE TX
75801-4421
US

IV. Provider business mailing address

P O BOX 817
PALESTINE TX
75802
US

V. Phone/Fax

Practice location:
  • Phone: 903-723-8210
  • Fax: 903-723-8310
Mailing address:
  • Phone: 903-723-8210
  • Fax: 903-723-8310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES DON JACKSON JR.
Title or Position: PHYSICIAN
Credential: MD, PA
Phone: 903-723-8210