MEDICARE: DR. ROBERT SEAN JACKSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	04-2105	KS
2	207XS0117X	Orthopaedic Surgery of the Spine Physician	04-2105	KS
3	207X00000X	Orthopaedic Surgery Physician	118992	MO
4	207XS0117X	Orthopaedic Surgery of the Spine Physician	118992	MO
5	207X00000X	Orthopaedic Surgery Physician	0428105	KS
6	207XS0117X	Orthopaedic Surgery of the Spine Physician	0428105	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	25755019	OTHER	BCBS KC
2	1826450	OTHER	UNITED HEALTH CARE
3	25755019	OTHER	BCBS OTHER
4	7665523	OTHER	AETNA

General Provider Information

NPI Number	:	1174551808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT SEAN JACKSON M.D.

Provider Business Mailing Address
First Line	:	3901 RAINBOW BLVD,
Second Line	:	MS#3017 UNIVERSITY OF KANSAS MEDICAL CENTER
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-0000
Country	:	US
Telephone Number	:	913-588-6100
Fax Number	:	913-588-8186

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	UNIVERSITY OF KANSAS MEDICAL CENTER
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-0000
Country	:	US
Telephone Number	:	913-588-6100
Fax Number	:	913-588-8186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	06/23/2011

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