Individual
DR. JACQUELINE LONGBOTHAM ACKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
118 W CASTLE LN, SAN ANTONIO, TX 78213-1803
(210) 341-6556
Mailing address
118 W CASTLE LN, SAN ANTONIO, TX 78213-1803
(210) 341-6556
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
G7549
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129409206
—
TX
01
—
P00902937
MEDICARE R/R
TX
Enumeration date
01/19/2006
Last updated
05/05/2017
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