MEDICARE: RYAN C JACKSON MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207RG0100X	Gastroenterology Physician	V8652	TX

General Provider Information

NPI Number	:	1407318223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN C JACKSON MD

Provider Business Mailing Address
First Line	:	950 E STATE HIGHWAY 114 STE 200
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-5261
Country	:	US
Telephone Number	:	214-424-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 CENTRAL DR STE 310
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76022-6029
Country	:	US
Telephone Number	:	817-267-8470
Fax Number	:

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

Provider Enumeration Date	:	04/01/2019
Last Update Date	:	07/07/2025

Similar Medicare Providers

1902875438 — CENTRAL PARK ENDOSCOPY CENTER LLC
Practice Location Address:

1600 CENTRAL DR STE 300
BEDFORD, TX
76022-6029

Practice Phone: 817-318-0235
Practice Fax: 817-318-0211

1154709814 — DR. BHAVIN MANISH PATEL M.D.
Practice Location Address:

1600 CENTRAL DR STE 310
BEDFORD, TX
76022-6029

Practice Phone: 817-267-8470
Practice Fax: 817-267-0396

1043976962 — TRINITY LEVINE
Practice Location Address:

1600 CENTRAL DR STE 160
BEDFORD, TX
76022-6029

Practice Phone: 469-788-8288
Practice Fax:

1164381331 — BEDFORD SURGERY CENTER LLC
Practice Location Address:

1600 CENTRAL DR STE 180
BEDFORD, TX
76022-6029

Practice Phone: 817-705-6517
Practice Fax:

1346199072 — NAFISSATOU SALAMI NP
Practice Location Address:

1600 CENTRAL DR STE 310
BEDFORD, TX
76022-6029

Practice Phone: 817-267-8470
Practice Fax: 817-267-0396

1770024333 — RUTH SZATKOWSKI RN
Practice Location Address:

88 MILL ST , APT 3
NEW BEDFORD, MA
02740-6029

Practice Phone: 774-313-9636
Practice Fax:

Directions to “ RYAN C JACKSON MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.