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General NPI Number Information
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NPI Number | 1033379524
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Entity Type | Individual
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Provider Name | STEVEN MICHAEL JACKSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 601 KEYSER AVE
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City | NATCHITOCHES
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State | LA
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Zip | 71457-6020
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Country | US
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Telephone | 318-354-2555
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Fax | 318-354-0101
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Provider Business Mailing Address
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Address Line | PO BOX 2475
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City | NATCHITOCHES
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State | LA
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Zip | 71457-2475
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Country | US
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Telephone | 318-663-6131
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Fax | 318-214-4651
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | DO.322073
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License Number State | LA
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