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NPI Code Detail

MEDICARE: DR. HOWARD FRANKLIN JACKSON DPM

MEDICARE: DR. HOWARD FRANKLIN JACKSON DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0131XFoot Surgery Podiatrist016003650IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2480004788OTHERILRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12780264OTHERILUNITED HEALTHCARE
30060101272OTHERILBLUE SHEILD
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255453718
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HOWARD FRANKLIN JACKSON DPM
Provider Business Mailing Address
First Line : 4601 STATE ST
Second Line : SUITE 310
City : EAST SAINT LOUIS
State : IL
Zip : 62205-1359
Country : US
Telephone Number : 618-875-7230
Fax Number : 618-875-7230
Provider Business Practice Location Address
First Line : 4601 STATE ST
Second Line : SUITE 310
City : EAST SAINT LOUIS
State : IL
Zip : 62205-1359
Country : US
Telephone Number : 618-875-7230
Fax Number : 618-875-7230
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2007
Last Update Date : 07/08/2007

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