Individual
DR. LESLIE W JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
710 SUNSET DR, LA GRANDE, OR 97850-1200
(541) 663-3000
(541) 975-5115
Mailing address
710 SUNSET DR, LA GRANDE, OR 97850-1200
(541) 663-3000
(541) 975-5115
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
9300627
NC
207RR0500X
Rheumatology Physician
M-11620
ID
207RR0500X
Rheumatology Physician
Primary
MD156467
OR
Other
Enumeration date
10/05/2006
Last updated
11/23/2021
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