Jackson, Keith A
Jackson, Keith A is an sole proprietor health care provider with primary practice located at 5405 Oberlin Dr Fl 2 , San Diego CA 92121-1700. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Otolaryngology, Allopathic & Osteopathic Physicians / Otology & Neurotology. Allopathic & Osteopathic Physicians / Otolaryngology is his primary health care specialty. Jackson, Keith A can be contacted via phone (858) 909-0770.Contact Information
Primary practice address
5405 Oberlin Dr Fl 2
San Diego CA 92121-1700
Phone: (858) 909-0770
Fax: (858) 909-0880
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Otolaryngology | 207Y00000X | G58187 | California |
| Allopathic & Osteopathic Physicians / Otology & Neurotology | 207YX0901X | 8547 | Nevada |
| Allopathic & Osteopathic Physicians / Otolaryngology | 207Y00000X | 8547 | Nevada |
Profile Details
| NPI number | 1124091970 |
|---|---|
| LBN Legal business name | Jackson, Keith A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 10th, 2006 |
| Last updated | Jan 25th, 2024 - about 10 months 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 | 1124091970 | NPPES |
| Nevada | MEDICAID | 002018083 |
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