# DR. JACKSON VANE

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

## Provider details

- **NPI number:** 1952608580
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | A120394 | CA | — |
| 2080P0204X | Pediatric Emergency Medicine (Pediatrics) Physician | RS2014-0568 | NM | Yes |

## Other

- **Enumeration date:** 02/16/2011
- **Last updated:** 12/15/2016