Provider Demographics
NPI:1386807832
Name:JACKSON-PAREKH, ROSEANNA (MD)
Entity type:Individual
Prefix:DR
First Name:ROSEANNA
Middle Name:
Last Name:JACKSON-PAREKH
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:PO BOX 161242
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78716-1242
Mailing Address - Country:US
Mailing Address - Phone:512-800-3187
Mailing Address - Fax:512-292-4458
Practice Address - Street 1:1215 RED RIVER ST
Practice Address - Street 2:STE 427
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1921
Practice Address - Country:US
Practice Address - Phone:512-555-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-04
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0126208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BR430OtherBCBS
TX8BR430OtherBCBS