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General NPI Number Information
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NPI Number | 1679549836
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Entity Type | Individual
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Provider Name | HENRY A JACKSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/27/2006
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Last Update Date | 09/23/2019
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Provider Practice Location Address
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Address Line | 4224 HOUMA BLVD STE 380
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City | METAIRIE
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State | LA
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Zip | 70006-2980
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Country | US
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Telephone | 504-454-5213
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Fax | 504-456-8053
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Provider Business Mailing Address
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Address Line | 4224 HOUMA BLVD 380 EJ PULMONARY MEDICINE EJPULM
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City | METAIRIE
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State | LA
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Zip | 70006-2980
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Country | US
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Telephone | 504-454-5213
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Fax | 504-456-8053
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | L010098
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License Number State | LA
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