Basic Information
| Provider Information | |||||||||
| NPI: | 1689654600 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACKSON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1720 MURCHISON | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155337465 | ||||||||
| FaxNumber: | 9155345289 | ||||||||
| Practice Location | |||||||||
| Address1: | 10555 VISTA DEL SOL DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799257943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155945925 | ||||||||
| FaxNumber: | 9155945926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | J7998 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.