Individual
KEITH A JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5405 OBERLIN DR FL 2, SAN DIEGO, CA 92121-1700
(858) 909-0770
(858) 909-0880
Mailing address
PO BOX 500877, SAN DIEGO, CA 92150-0877
(858) 279-4221
(858) 279-4223
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
8547
NV
207Y00000X
Otolaryngology Physician
G58187
CA
207YX0901X
Otology & Neurotology Physician
8547
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002018083
—
NV
Enumeration date
02/10/2006
Last updated
01/25/2024
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