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General NPI Number Information
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NPI Number | 1679969877
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Entity Type | Individual
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Provider Name | VICTOR S JACKSON MD
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Gender | Male
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 1701 23RD ST
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City | GALVESTON
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State | TX
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Zip | 77550-7901
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Country | US
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Telephone | 409-539-5312
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Fax | 409-207-5016
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Provider Business Mailing Address
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Address Line | 5826 BROADWAY ST STE 3734
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City | GALVESTON
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State | TX
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Zip | 77551-4385
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Country | US
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Telephone | 409-539-5312
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Fax | 409-207-5016
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R5745
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License Number State | TX
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