| Gregory M Jackson, Md, Pa | |
|
4220 Mccullough Ave San Antonio TX 78212-1910 | |
| (210) 829-0700 | |
| (210) 829-0714 |
| Full Name | Gregory M Jackson, Md, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 4220 Mccullough Ave, San Antonio, Texas |
| Authorized Official Name and Position | Cheryl M Jackson (OFFICE MANAGER) |
| Authorized Official Contact | 2108290700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gregory M Jackson, Md, Pa 4220 Mccullough Ave San Antonio TX 78212-1910 Ph: (210) 829-0700 | Gregory M Jackson, Md, Pa 4220 Mccullough Ave San Antonio TX 78212-1910 Ph: (210) 829-0700 |
| NPI Number | 1861670994 |
|---|---|
| Provider Enumeration Date | 01/31/2008 |
| Last Update Date | 11/22/2010 |
| Medicare PECOS PAC ID | 7416144415 |
|---|---|
| Medicare Enrollment ID | O20101202001036 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861670994 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Gregory M Jackson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184738825 PECOS PAC ID: 8921295924 Enrollment ID: I20101202001087 |
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