# CARL-CHRISTIAN ANDREW JACKSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1235355173
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | 036-106668 | IL | — |
| 2086S0120X | Pediatric Surgery Physician | 231415 | MA | — |
| 2086S0120X | Pediatric Surgery Physician | MD18790 | RI | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | A88272 | CA | — |

## Other

- **Enumeration date:** 04/18/2007
- **Last updated:** 11/26/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00A882720 | — | CA |