RICHARD T JACKSON (NPI# 1407859424) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407859424 |
| Entity Type | Individual |
| Full Name | RICHARD T JACKSON |
| Credential | D.P.M. |
| Practice Address |
7601 W Jefferson Blvd Fort Wayne IN 46804-4133 |
| Mailing Address |
Po Box 2526 Fort Wayne IN 46801-2526 |
| Practice Telephone | 2604368686 |
| Practice Fax Number | 2604868585 |
| Mailing Telephone | 2604368686 |
| Mailing Fax Number | 2604368585 |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2016-11-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213E00000X | Podiatrist | 07000729A | IN | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ANTHEM | 00000089403 | 01 | |
| IN | 100359040A | 05 | |
| RAILROAD MEDICARE | 480026551 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629520770 | Richard Allen Jackson | Social Worker | 201 W Laurel St, Brainerd, MN 56401-3902 | 2016-10-25 |
| 1386924363 | Richard Ray Jackson | Social Worker | 104 S Ridge Ave, Troy, OH 45373-2704 | 2011-08-23 |
| 1124240197 | Richard Jackson | Psychologist | 2650 West 2700 South, Syracuse, UT 84075 | 2007-05-02 |
| 1508081993 | Richard Jackson | Psychiatry & Neurology | E 4111 Andover Road Suite 220, Bloomfield Hills, MI 48302 | 2007-04-13 |
| 1851478101 | Richard Jackson | Pharmacist | 420 Delaware St Se # Mmc812, Minneapolis, MN 55455-0341 | 2006-11-01 |
| 1972616134 | Richard Pharus Jackson | Optometrist | 216 W Washington St, Anthony, TX 79821-9304 | 2006-08-15 |
| 1801810163 | Richard Edwin Jackson | Dentist | 109 Timbermill Dr, Lexington, SC 29073-7138 | 2006-07-27 |
| 1366483406 | Richard D Jackson | Family Medicine | 29 Eastbrook Rd, Ronks, PA 17572-9769 | 2006-06-09 |
| 1659328060 | Richard Jackson | Emergency Medicine | 505 Regency Xing, Southlake, TX 76092-9501 | 2006-05-30 |
| 1174587505 | Richard E Jackson | Physician Assistant | 21260 Olean Blvd Ste 200, Port Charlotte, FL 33952-6742 | 2006-04-13 |
| Street Address |
7601 W JEFFERSON BLVD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-4133 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497758429 | Fort Wayne Orthopaedics LLC | Orthopaedic Surgery | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2005-05-23 |
| 1801456553 | Elizabeth Schaefer | Specialist/Technologist | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2019-06-15 |
| 1417514480 | Courtney Mangan | Nurse Practitioner | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2019-05-24 |
| 1881177798 | Lindsey M. Hertenstein | Registered Nurse | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2018-09-07 |
| 1912407099 | Heather Korte | Registered Nurse | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2018-02-15 |
| 1902314958 | John Grimshaw | Registered Nurse | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2018-01-11 |
| 1053836882 | Alex Villavicencio | Nurse Practitioner | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2017-08-14 |
| 1841721735 | Abbey K. Bunnell | Nurse Practitioner | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2017-03-23 |
| 1093256950 | Jessica A. Wiedemann | Nurse Practitioner | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2017-03-13 |
| 1245786672 | Abigail Vanlaningham | Physician Assistant | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2016-08-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417337353 | Hazim Ibrahim | Podiatrist | 7527 Thoroughbred Dr Apt 3d, Fort Wayne, IN 46804 | 2015-06-05 |
| 1760683593 | Toes R Us, Inc. | Podiatrist | 6200 Bluffton Rd, Fort Wayne, IN 46809-2260 | 2007-05-30 |
| 1871605147 | Dennis John Chubinski | Podiatrist | 8028 Carnegie Blvd., 400, Fort Wayne, IN 46804-5788 | 2006-08-31 |
| 1114956844 | David K Wysong | Podiatrist | 3012 E State Blvd, Fort Wayne, IN 46805-4737 | 2006-07-03 |
| 1235182643 | Richard M. Hilker, Dpm, P.C. | Podiatrist | 10323 Dawsons Creek Blvd, Bldg. 10-c, Fort Wayne, IN 46825-1910 | 2006-05-18 |
| 1134104474 | Lynn H Stafford | Podiatrist | 7559 W Jefferson Blvd, Fort Wayne, IN 46804-4131 | 2005-12-09 |
| 1487637377 | Richard M Hilker | Podiatrist | 10323 Dawsons Creek, Bldg 10 C, Fort Wayne, IN 46825-1910 | 2005-11-23 |
| 1508867177 | Gary Michael Torkeo | Podiatrist | 4011 W Jefferson Blvd, Suite 175, Fort Wayne, IN 46804-6853 | 2005-08-09 |
| 1346247061 | Michael Steven Worpell | Podiatrist | 1234 E Dupont Rd, 2 1, Fort Wayne, IN 46825-1545 | 2005-07-07 |
| 1760486393 | Lincoln Pedic Clinic, Inc. | Podiatrist | 12311 Autumn Breeze Dr, Fort Wayne, IN 46845-9111 | 2005-06-10 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
Please comment or provide details below to improve the information on RICHARD T JACKSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.