Individual
MR. PATRICK LOUIS JACKSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
58110 W W HARLEAUX ST, PLAQUEMINE, LA 70764-3230
(225) 385-4251
(225) 385-4251
Mailing address
58110 W W HARLEAUX ST, P.O . BOX -986, PLAQUEMINE, LA 70764-3230
(225) 385-4251
(225) 385-4251
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
332B00000X
LA
Other
Enumeration date
04/13/2007
Last updated
07/08/2007
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