Healthcare Provider Details

I. General information

NPI: 1386846491
Provider Name (Legal Business Name): DOWNTOWN PHYSICIANS MEDICAL GRP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S FLOWER STREET SUITE 204
LOS ANGELES CA
90017
US

IV. Provider business mailing address

801 S FLOWER STREET SUITE 204
LOS ANGELES CA
90017
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-7026
  • Fax: 214-623-9985
Mailing address:
  • Phone: 213-481-7026
  • Fax: 214-623-9985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. HOWARD RAYMOND JACKSON
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 213-481-7026