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Individual
SHAUN CHADRICK JACKSON
Active
Individual
SHAUN CHADRICK JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
M9372
TX
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
M9372
TX
208VP0000X
Pain Medicine Physician
Primary
M9372
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1984007-01
—
TX
01
—
8L0027
MEDICARE PTAN
TX
01
—
M9372
MEDICAL LICENSE
TX
Enumeration date
05/16/2008
Last updated
06/03/2020
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