Individual
CHARITY L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
402 N TEJON ST STE 200, COLORADO SPRINGS, CO 80903
(719) 633-3850
(719) 227-0840
Mailing address
402 N TEJON ST STE 200, COLORADO SPRINGS, CO 80903-1142
(719) 633-3850
(719) 227-0840
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
DR.0059719
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
283583701
—
TX
05
—
283583702
—
TX
Enumeration date
04/09/2008
Last updated
06/14/2018
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