WALTER OSBORNE JACKSON

FORT WAYNE, IN
NPI1902982796
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207P00000X Emergency Medicine
(Licence: IN  01067150A)
Additional Taxonomies207P00000X Emergency Medicine
(Licence: SC  23797)
207P00000X Emergency Medicine
(Licence: GA  48786)
207P00000X Emergency Medicine
(Licence: ND  7739)
207P00000X Emergency Medicine
(Licence: CA  A070415)
Enumeration Date2006-10-27
Last Update Date2013-06-05
Business Address
Dr. WALTER OSBORNE JACKSON MD
10329 GREENOAK BLVD
FORT WAYNE, IN 46814-9546
Phone number: 260-616-0681
Mailing Address
Dr. WALTER OSBORNE JACKSON MD
10329 GREENOAK BLVD
FORT WAYNE, IN 46814-9546
Phone number: 260-616-0681