Provider Demographics
NPI:1699113597
Name:JACKSON, RUTH ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ELAINE
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 1:141 GRAND VW
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-6690
Mailing Address - Country:US
Mailing Address - Phone:830-251-0967
Mailing Address - Fax:
Practice Address - Street 1:12030 BANDERA RD STE 128
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4776
Practice Address - Country:US
Practice Address - Phone:210-695-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10046834207R00000X
TXQ6852207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine