Provider Demographics
NPI:1982654828
Name:JACKSON, ROBERT FRANKLIN II (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FRANKLIN
Last Name:JACKSON
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:HUNTERTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46748-0670
Mailing Address - Country:US
Mailing Address - Phone:260-748-3650
Mailing Address - Fax:260-748-3651
Practice Address - Street 1:1721 MAGNAVOX WAY
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1537
Practice Address - Country:US
Practice Address - Phone:260-748-3650
Practice Address - Fax:260-748-3651
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001273207X00000X
WI21371207X00000X
WI76572207X00000X
IN02001273A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0426440001OtherDME
IN100352280Medicaid
IN000000082970OtherANTHEM BCBS
IN02001273OtherLICENSE
IN000000082970OtherANTHEM BCBS
IN100352280Medicaid
IN292270CMedicare PIN
IN02001273OtherLICENSE