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General NPI Number Information
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NPI Number | 1780845818
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Entity Type | Individual
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Provider Name | SHAUN WILLIAM JACKSON MD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2008
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | 4800 SAND POINT WAY NE SEATTLE CHILDREN'S HOSPITAL, DIVISION OF NEPHROLOGY
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City | SEATTLE
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State | WA
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Zip | 98105
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Country | US
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Telephone | 857-891-6790
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 SAND POINT WAY NE SEATTLE CHILDREN'S HOSPITAL, DIVISION OF NEPHROLOGY
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City | SEATTLE
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State | WA
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Zip | 98105-3901
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Country | US
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Telephone | 857-891-6790
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 225159
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2080P0216X
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Taxonomy Name | Pediatric Rheumatology Physician
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License Number | MD60002199
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 2080P0210X
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Taxonomy Name | Pediatric Nephrology Physician
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License Number | MD60002199
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License Number State | WA
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