Provider Demographics
NPI:1760646392
Name:JACKSON, JAMES JASON (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JASON
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8609 NE 129TH ST
Mailing Address - Street 2:
Mailing Address - City:JONES
Mailing Address - State:OK
Mailing Address - Zip Code:73049-3416
Mailing Address - Country:US
Mailing Address - Phone:053-885-4804
Mailing Address - Fax:
Practice Address - Street 1:941 W I 35 FRONTAGE RD STE 164
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-7375
Practice Address - Country:US
Practice Address - Phone:405-285-2994
Practice Address - Fax:405-285-2997
Is Sole Proprietor?:No
Enumeration Date:2008-07-13
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27258202K00000X, 208100000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation