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Contact Information

PENELOPE A JACKSON, MD
2005 ROCKVIEW DRIVE
GRANBURY, TX76049
 Phone: 817-579-1005
 Fax: 817-579-1093
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for PENELOPE A JACKSON · (Female)

NPI # 1548240682
Status Active
Credentials MD
Entity Individual
Enumeration date 01/17/2006
Last updated 03/18/2014 - About 12 years ago
Sole proprietor 1 No
Identifiers
  • TX License # L2078
Hospital affiliation(s)
  • LAKE GRANBURY MEDICAL CENTER - (Acute Care)
    1310 PALUXY RD
    GRANBURY, TX 76048
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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