Provider Demographics
NPI:1689629891
Name:JACKSON, HOWARD WOODROW JR (RDCS)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:WOODROW
Last Name:JACKSON
Suffix:JR
Gender:M
Credentials:RDCS
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Mailing Address - Street 1:25 KANOME ROAD
Mailing Address - Street 2:
Mailing Address - City:LECOMPTE
Mailing Address - State:LA
Mailing Address - Zip Code:71346-9566
Mailing Address - Country:US
Mailing Address - Phone:318-776-9949
Mailing Address - Fax:413-653-8834
Practice Address - Street 1:301 W BOUNDARY AVE
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-3427
Practice Address - Country:US
Practice Address - Phone:318-648-3064
Practice Address - Fax:318-628-3285
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2009-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA16604246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography