Jackson, Charles G
Jackson, Charles G is an sole proprietor health care provider with primary practice located at 1200 112Th Ave Ne Suite C-210, Bellevue WA 98004-3732. He recently has only one registered license in Allopathic & Osteopathic Physicians / Allergy, which is considered as his primary health care specialty. Jackson, Charles G can be contacted via phone (425) 454-2191.Contact Information
Primary practice address
1200 112Th Ave Ne Suite C-210
Bellevue WA 98004-3732
Phone: (425) 454-2191
Fax: (425) 453-1270
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Allergy | 207KA0200X | MD00014267 | Washington |
Profile Details
| NPI number | 1851305866 |
|---|---|
| LBN Legal business name | Jackson, Charles G |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 27th, 2006 |
| Last updated | Jul 7th, 2009 - about 15 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1851305866 | NPPES |
| Washington | MEDICAID | 1039247 |
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