Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 01062266A | IN |
N | 207XS0117X | Orthopaedic Spine Surgeon | 01062266A | IN |
NPI | 1174627640 |
---|---|
Provider Name | Dr. Gabriel E Jackson |
First Address | Indianapolis, IN 46278-1381 |
Second Address | Brownsburg, IN 46112-9354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200860260 | (05) | IN |