Individual
DR. PATRICIA A JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1111 MEDICAL CENTER BLVD, SUITE N408, MARRERO, LA 70072
(504) 349-2908
(504) 378-0019
Mailing address
6019 CONSTANCE ST, NEW ORLEANS, LA 70118-5806
(504) 349-2908
(504) 378-0019
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
21655
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1660361
—
LA
Enumeration date
09/20/2006
Last updated
05/18/2011
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