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:
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Health care specialties

SpecialtyCodeLicense #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 11 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124091970 NPPES
Nevada MEDICAID 002018083

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