Provider Demographics
NPI:1821090697
Name:JACKSON, JEFFREY ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALLEN
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 1:13828 DRAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-2662
Mailing Address - Country:US
Mailing Address - Phone:713-705-6972
Mailing Address - Fax:281-494-6410
Practice Address - Street 1:13828 DRAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-2662
Practice Address - Country:US
Practice Address - Phone:713-705-6972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF55852084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01031010OtherRR MEDICARE
TXP00866614OtherMEDICARE RAILROAD
TX1821090697OtherBLUE CROSS BLUE SHIELD
TX128033105Medicaid
TXTXB135494Medicare PIN
TXP01031010OtherRR MEDICARE
D66623Medicare UPIN
TXP00866614OtherMEDICARE RAILROAD