1417048653 NPI number — ERICA M BROWN-JACKSON MD

Table of content: ERICA M BROWN-JACKSON MD (NPI 1417048653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417048653 NPI number — ERICA M BROWN-JACKSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN-JACKSON
Provider First Name:
ERICA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417048653
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 PONY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT ROSE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70087-3638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-717-5454
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 VETERANS BLVD
Provider Second Line Business Practice Location Address:
SUITE 205A
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70005-2957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-837-5200
Provider Business Practice Location Address Fax Number:
504-837-5260
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  200224 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com