Individual
DR. DAVID BRUCE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3233 GRAND AVE # N415, CHINO HILLS, CA 91709-1489
(626) 821-5903
Mailing address
3233 GRAND AVE # N415, CHINO HILLS, CA 91709-1489
(626) 821-5903
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G68901
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063564748
—
CA
01
—
P01433610
RAILROAD MEDICARE
CA
Enumeration date
01/16/2007
Last updated
02/10/2016
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