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Organization
PATRICIA JACKSON MD, LLC
Active
Organization
PATRICIA JACKSON MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES O THEIS (AUTHORIZED OFFICIAL)
(504) 349-2908
Entity
Organization
Contact information
Practice address
1111 MEDICAL CENTER BLVD, SUITE N408, MARRERO, LA 70072
(504) 349-2908
(504) 378-0019
Mailing address
6019 CONSTANCE ST, NEW ORLEANS, LA 70118-5806
(504) 349-2908
(504) 378-0019
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
09/20/2006
Last updated
08/21/2018
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