MEDICARE: ROBERT J 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	207T00000X	Neurological Surgery Physician	A71112	CA

General Provider Information

NPI Number	:	1023003605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J JACKSON M.D.

Provider Business Mailing Address
First Line	:	23961 CALLE DE LA MAGDALENA
Second Line	:	504
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3616
Country	:	US
Telephone Number	:	949-588-5800
Fax Number	:	949-380-3344

Provider Business Practice Location Address
First Line	:	23961 CALLE DE LA MAGDALENA
Second Line	:	504
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3616
Country	:	US
Telephone Number	:	949-588-5800
Fax Number	:	949-380-3344

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	04/15/2008

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