Healthcare Provider Details

I. General information

NPI: 1972477933
Provider Name (Legal Business Name): MS. DENISE MASON JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HOLCOMBE BLVD
HOUSTON TX
77030-4000
US

IV. Provider business mailing address

1515 HOLCOMBE BLVD
HOUSTON TX
77030-4000
US

V. Phone/Fax

Practice location:
  • Phone: 713-794-1212
  • Fax:
Mailing address:
  • Phone: 713-794-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number672245
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: