Individual
HOWARD B JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13020 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0925
(813) 978-9700
(813) 558-6134
Mailing address
13020 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0925
(813) 978-9700
(813) 558-6134
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
ME79194
FL
208VP0014X
Interventional Pain Medicine Physician
Primary
ME79194
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
250011193
RAILROAD MEDICARE
FL
05
—
258188400
—
FL
01
—
270565
AVMED
FL
01
—
49333
BLUE CROSS/BLUE SHIELD
FL
01
—
5320656
AETNA
FL
01
—
8294118
CIGNA
FL
Enumeration date
07/07/2005
Last updated
10/12/2017
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