Individual
JOHN G JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13030 HIGHWAY 308, LAROSE, LA 70373-2001
(985) 798-7000
(985) 798-7021
Mailing address
13030 HIGHWAY 308, LAROSE, LA 70373-2001
(985) 798-7000
(985) 798-7021
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD019331
LA
207Q00000X
Family Medicine Physician
MD15556
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1030589
—
LA
Enumeration date
12/07/2005
Last updated
01/30/2023
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