Jackson, Brent Clarence

Jackson, Brent Clarence is an individual health care provider with primary practice located at 2 W Fern Ave , Redlands CA 92373-5916. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Jackson, Brent Clarence can be contacted via phone (909) 793-3311.

Contact Information

Primary practice address
2 W Fern Ave Redlands CA 92373-5916
Phone: (909) 793-3311
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X A64902 California

Profile Details

NPI number 1346229382
LBN Legal business name Jackson, Brent Clarence
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 10th, 2006
Last updated Jun 17th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346229382 NPPES
California Other 00A649020 BLUE SHIELD OF CA
California MEDICAID 00A649020 BLUE SHIELD OF CA
California Other 113712291 BLUE SHIELD OF CA
California Other 113712291 92123 0000 BLUE SHIELD OF CA

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