Individual
DR. LANCE ELLIOT JACKSON
Active
Individual
DR. LANCE ELLIOT JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., F.A.C.S.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
L5777
TX
207Y00000X
Otolaryngology Physician
L5777
TX
207YX0602X
Otolaryngic Allergy Physician
L5777
TX
207YX0901X
Otology & Neurotology Physician
Primary
L5777
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157518501
—
TX
01
—
7047136
AETNA
TX
01
—
8H5000
BLUE SHIELD
TX
01
—
MDL5777
WORKERS COMP
TX
01
—
P00019999
RAILROAD MEDICARE
TX
Enumeration date
07/05/2006
Last updated
01/25/2013
Update your record
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