Jackson, Charles William

Jackson, Charles William is an individual health care provider with primary practice located at 17122 Beach Blvd Suite 102, Huntington Beach CA 92647-5992. He recently has only one registered license in Allopathic & Osteopathic Physicians / General Practice, which is considered as his primary health care specialty. Jackson, Charles William can be contacted via phone (714) 847-6545.

Contact Information

Primary practice address
17122 Beach Blvd Suite 102 Huntington Beach CA 92647-5992
Phone: (714) 847-6545
Fax: (714) 847-6547
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X G35311 California

Profile Details

NPI number 1083662845
LBN Legal business name Jackson, Charles William
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 4th, 2006
Last updated Jul 30th, 2010 - 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083662845 NPPES
California MEDICAID 00G353110

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