# DR. CODY RONALD JACKSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1770715146
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2083X0100X | Occupational Medicine Physician | A162265 | CA | — |
| 208D00000X | General Practice Physician | A162265 | CA | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | — | — | — |

## Other

- **Enumeration date:** 08/18/2009
- **Last updated:** 07/05/2022