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General NPI Number Information
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NPI Number | 1598937203
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Entity Type | Organization
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Legal Business Name | O. B. JACKSON, JR.,MD, PA
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 3509 LAWTON AVE
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City | AUSTIN
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State | TX
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Zip | 78731-6112
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Country | US
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Telephone | 512-451-0234
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Fax | 512-451-3566
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Provider Business Mailing Address
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Address Line | 3509 LAWTON AVE
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City | AUSTIN
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State | TX
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Zip | 78731-6112
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Country | US
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Telephone | 512-451-0234
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Fax | 512-451-3566
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OSCAR B JACKSON JR.
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Credential | M.D.
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Telephone | 512-451-0234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | D8288
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License Number State | TX
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