MEDICARE: DR. RICHARD ALLEN 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	207R00000X	Internal Medicine Physician	D8289	TX

General Provider Information

NPI Number	:	1598761751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ALLEN JACKSON MD

Provider Business Mailing Address
First Line	:	1200 BINZ ST
Second Line	:	SUITE 1410
City	:	HOUSTON
State	:	TX
Zip	:	77004-6900
Country	:	US
Telephone Number	:	713-400-9990
Fax Number	:	713-400-9988

Provider Business Practice Location Address
First Line	:	1200 BINZ ST
Second Line	:	SUITE 1410
City	:	HOUSTON
State	:	TX
Zip	:	77004-6900
Country	:	US
Telephone Number	:	713-400-9990
Fax Number	:	713-400-9988

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	02/05/2015

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