Organization
GAIL N JACKSON MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GAIL N JACKSON M.D., (CEO/OWNER)
(310) 659-2666
Entity
Organization
Contact information
Practice address
1333 OCEAN AVE, SANTA MONICA, CA 90401-1023
(310) 451-2300
(310) 451-2325
Mailing address
PO BOX 11692, MARINA DEL REY, CA 90295-7692
(310) 451-2300
(310) 451-2325
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
G41783
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ET547A
MEDICARE
CA
Enumeration date
08/30/2006
Last updated
05/19/2012
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