MEDICARE: JAY 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	207Q00000X	Family Medicine Physician	BP10054654	TX

General Provider Information

NPI Number	:	1760863138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY JACKSON MD

Provider Business Mailing Address
First Line	:	399 REID RD
Second Line	:
City	:	JUNCTION
State	:	TX
Zip	:	76849-3049
Country	:	US
Telephone Number	:	325-446-3305
Fax Number	:

Provider Business Practice Location Address
First Line	:	399 REID RD
Second Line	:
City	:	JUNCTION
State	:	TX
Zip	:	76849-3049
Country	:	US
Telephone Number	:	325-446-3305
Fax Number	:

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

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	11/18/2024

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