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General NPI Number Information
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NPI Number | 1457742306
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Entity Type | Organization
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Legal Business Name | ROBERT M JACKSON, M.D.
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Dates
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Enumeration Date | 02/13/2015
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Last Update Date | 02/13/2015
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Provider Practice Location Address
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Address Line | 41250 12TH ST W STE C
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City | PALMDALE
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State | CA
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Zip | 93551-1444
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Country | US
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Telephone | 661-224-1300
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Fax | 661-224-1333
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Provider Business Mailing Address
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Address Line | 41250 12TH ST W STE C
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City | PALMDALE
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State | CA
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Zip | 93551-1444
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Country | US
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Telephone | 661-224-1300
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Fax | 661-224-1333
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JUDY ANN JACKSON
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Credential |
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Telephone | 661-224-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | G50418
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License Number State | CA
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