Individual
LEON S JACKSON
Active
Individual
LEON S JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
11348
NV
2085R0202X
Diagnostic Radiology Physician
G68430
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100505784
—
NV
Enumeration date
10/13/2005
Last updated
07/24/2015
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