Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1782 | TX |
N | 222Z00000X | Podiatrist | 1782 | TX |
N | 213EP1101X | Primary Podiatric Medicine | 1782 | TX |
N | 2081S0010X | Sports Medicine | 1782 | TX |
N | 213ES0000X | Sports Medicine | 1782 | TX |
Y | 213ES0103X | Foot & Ankle Surgery | 1782 | TX |
N | 213ES0131X | Foot Surgery | 1782 | TX |
NPI | 1386619716 |
---|---|
Provider Name | Matthew W Jackman |
First Address | Denison, TX 75020-1544 |
Second Address | Denison, TX 75020-1544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 09/12/2020 |