Provider Demographics
NPI:1790786168
Name:ORMAND, JACKSON EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JACKSON
Middle Name:EDWARD
Last Name:ORMAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1521 S STAPLES ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3150
Mailing Address - Country:US
Mailing Address - Phone:361-888-8271
Mailing Address - Fax:361-885-3699
Practice Address - Street 1:1521 S STAPLES ST
Practice Address - Street 2:SUITE 700
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3150
Practice Address - Country:US
Practice Address - Phone:361-888-8271
Practice Address - Fax:361-885-3699
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD7224207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129679004Medicaid
TXB25284Medicare UPIN
TX129679004Medicaid