Individual
DR. PETER J JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
504 S SIERRA MADRE BLVD, PASADENA, CA 91107-5240
(626) 795-8811
(626) 795-0935
Mailing address
504 S SIERRA MADRE BLVD, PASADENA, CA 91107-5240
(626) 795-8811
(626) 795-0935
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
G46502
CA
Other
Enumeration date
10/03/2006
Last updated
07/08/2007
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