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NPI Code Detail

MEDICARE: RACHAEL MAYER JACKSON MD

MEDICARE: RACHAEL MAYER JACKSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianR8017TX
2390200000XStudent in an Organized Health Care Education/Training Program
3208000000XPediatrics Physician331225LA

General Provider Information

NPI Number : 1427445659
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHAEL MAYER JACKSON MD
Provider Business Mailing Address
First Line : 5959 S SHERWOOD FOREST BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70816-6038
Country : US
Telephone Number : 225-665-4554
Fax Number : 225-765-9196
Provider Business Practice Location Address
First Line : 311 VETERANS BLVD STE B
Second Line :
City : DENHAM SPRINGS
State : LA
Zip : 70726-4726
Country : US
Telephone Number : 225-665-4554
Fax Number : 225-665-6995
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2015
Last Update Date : 03/14/2023

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