Individual
ROBERT HUTCHINSON JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1501 KINGS HWY, DEPARTMENT OF MEDICINE, SHREVEPORT, LA 71103-4228
(318) 813-2528
(318) 813-2565
Mailing address
1501 KINGS HWY, DEPARTMENT OF MEDICINE, SHREVEPORT, LA 71103-4228
(318) 813-2528
(318) 813-2565
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
016845
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1360694
—
LA
Enumeration date
07/20/2006
Last updated
10/15/2009
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