Provider Demographics
NPI:1083620967
Name:JACKSON, CARLAYNE E (MD)
Entity type:Individual
Prefix:
First Name:CARLAYNE
Middle Name:E
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 FLOYD CURL DR FL 8
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3931
Mailing Address - Country:US
Mailing Address - Phone:210-450-9700
Mailing Address - Fax:210-450-6039
Practice Address - Street 1:8300 FLOYD CURL DR FL 8
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3931
Practice Address - Country:US
Practice Address - Phone:210-450-9700
Practice Address - Fax:210-450-6039
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH44352084N0008X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110537105OtherCSHCN
TX130008727OtherMEDICARE RAILROAD
TX110537104Medicaid
TX8L10739Medicare PIN