Jackson, Dorothy Louise
Jackson, Dorothy Louise is an sole proprietor health care provider with primary practice located at 1114 W Bow St , Tyler TX 75702-5137. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Jackson, Dorothy Louise can be contacted via phone (903) 595-5595.Contact Information
Primary practice address
1114 W Bow St
Tyler TX 75702-5137
Phone: (903) 595-5595
Fax: (903) 595-5985
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | N1355 | Texas |
Profile Details
| NPI number | 1922071042 |
|---|---|
| LBN Legal business name | Jackson, Dorothy Louise |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 9th, 2006 |
| Last updated | Mar 20th, 2015 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1922071042 | NPPES |
| Texas | MEDICAID | 199916104 |
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