Healthcare Provider Details

I. General information

NPI: 1447778154
Provider Name (Legal Business Name): JESSICA LEIGH HOUSTON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 USA MEDICAL CENTER DR
MOBILE AL
36617-2300
US

IV. Provider business mailing address

2451 USA MEDICAL CENTER DR
MOBILE AL
36617-2300
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-7207
  • Fax: 251-471-7468
Mailing address:
  • Phone: 251-471-7870
  • Fax: 251-471-7468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO2113
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: