Individual
LEON S JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
118 E HASKELL ST, WINNEMUCCA, NV 89445-3247
(608) 788-8103
(608) 788-8799
Mailing address
2031 32ND ST S, LA CROSSE, WI 54601-7099
(608) 788-8103
(608) 788-8799
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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