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NPI Code Detail

MEDICARE: ROBERT E JACKSON III M.D.

MEDICARE: ROBERT E JACKSON III M.D.
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
1207U00000XNuclear Medicine PhysicianE4425TX

General Provider Information

NPI Number : 1659348555
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT E JACKSON III M.D.
Provider Business Mailing Address
First Line : PO BOX 3856
Second Line :
City : AMARILLO
State : TX
Zip : 79116-3856
Country : US
Telephone Number : 806-358-4596
Fax Number : 806-358-6726
Provider Business Practice Location Address
First Line : 1901 PORT LN
Second Line :
City : AMARILLO
State : TX
Zip : 79106-2430
Country : US
Telephone Number : 806-358-4596
Fax Number : 806-358-6726
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2006
Last Update Date : 10/30/2013

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