Provider Demographics
NPI:1326014697
Name:JACKSON, LINDA SLAYTON (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SLAYTON
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 MEMORIAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-8383
Mailing Address - Country:US
Mailing Address - Phone:910-964-0589
Mailing Address - Fax:
Practice Address - Street 1:1818 MEMORIAL DR STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-8383
Practice Address - Country:US
Practice Address - Phone:713-522-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101225086208000000X
NC2008-02032208000000X
TXS2351208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics