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RANDY ALAN JACKSON M.D. NPI 1689832768


NPI Information

NPI: 1689832768
Provider Name: RANDY ALAN JACKSON, M.D.
Classification: Internal Medicine - 207R00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
2602 SAINT MICHAEL DR
SUITE 205
TEXARKANA, TX
ZIP 75503
Phone: (903) 614-5111
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Randy Alan Jackson, M.D. is an internal medicine in Texarkana, TX with 19 years of experience. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. Randy Alan Jackson, M.D. NPI is 1689832768. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF TEXAS MEDICAL SCHOOL AT HOUSTON
Graduation Year:2005

The provider's business location address is:

2602 SAINT MICHAEL DR
SUITE 205
TEXARKANA, TX
ZIP 75503-387
Phone: (903) 614-5111

The NPI 1689832768 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/27/2008 and was last updated on 5/26/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207R00000XInternal MedicineN0854TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
18L8592MEDICARE PIN
2200544901MEDICAIDTEXAS
3200235880 AMEDICAIDOKLAHOMA
48BU284OTHERTEXASBCBS OF TEXAS
5176329001MEDICAIDARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.