Individual
DR. CHARLES WILLIAM JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
17122 BEACH BLVD, SUITE 102, HUNTINGTON BEACH, CA 92647-5992
(714) 847-6545
(714) 847-6547
Mailing address
17122 BEACH BLVD, SUITE 102, HUNTINGTON BEACH, CA 92647-5992
(714) 847-6545
(714) 847-6547
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
G35311
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G353110
—
CA
Enumeration date
05/04/2006
Last updated
07/30/2010
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