Provider Demographics
NPI:1598761751
Name:JACKSON, RICHARD ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1200 BINZ ST
Mailing Address - Street 2:SUITE 1410
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6900
Mailing Address - Country:US
Mailing Address - Phone:713-400-9990
Mailing Address - Fax:713-400-9988
Practice Address - Street 1:1200 BINZ ST
Practice Address - Street 2:SUITE 1410
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6900
Practice Address - Country:US
Practice Address - Phone:713-400-9990
Practice Address - Fax:713-400-9988
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2015-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXD8289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD66613Medicare UPIN