Basic Information
| Provider Information | |||||||||
| NPI: | 1538190830 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT J JACKSON M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23961 CALLE DE LA MAGDALENA | ||||||||
| Address2: | 504 | ||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926533616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495885800 | ||||||||
| FaxNumber: | 9493803344 | ||||||||
| Practice Location | |||||||||
| Address1: | 23961 CALLE DE LA MAGDALENA | ||||||||
| Address2: | 504 | ||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926533616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495885800 | ||||||||
| FaxNumber: | 9493803344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 11/06/2007 | ||||||||
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| AuthorizedOfficialLastName: | JACKSON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9495885800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | A71112 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.