NPIMap

Organization Active NPI

J. Don Jackson Jr, MD, PA

  • Surgery Physician
  • Palestine, TX
National Provider Identifier
1922150663
Registry record updated Oct 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
J. DON JACKSON JR, MD, PA
Practice address
300 Willow Creek Pkwy
Suite 200 a
Palestine, TX 75801-4421
Phone
(903) 723-8210
Fax
(903) 723-8310
NPI assigned
Jan 16, 2007
Last updated
Oct 4, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. James Don Jackson Jr., MD, PANPI 1841296712
Title
Physician
Phone
(903) 723-8210

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

300 Willow Creek Pkwy
Suite 200 a
Palestine, TX 75801-4421

Mailing address

P O Box 817
Palestine, TX 75802
Phone (903) 723-8210

Other identifiers 1

IdentifierTypeStateIssuer
178962001MedicaidTX

Other names 1

  • ADVANCED SURGERY Other name

National Provider Directory

National Provider Directory

Locations

2900 S Loop 256
Ste 100
Palestine, TX 75801
Phone (903) 723-8210

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286150400000",
    "number": "1922150663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 817",
            "city": "PALESTINE",
            "state": "TX",
            "postal_code": "75802",
            "telephone_number": "903-723-8210",
            "fax_number": "903-723-8310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 WILLOW CREEK PKWY",
            "address_2": "SUITE 200 A",
            "city": "PALESTINE",
            "state": "TX",
            "postal_code": "758014421",
            "telephone_number": "903-723-8210",
            "fax_number": "903-723-8310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. DON JACKSON JR, MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2010-10-04",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "DON",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "903-723-8210",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD, PA"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "178962001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADVANCED SURGERY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Palestine, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.