Individual
DR. TODD EDWARD JACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7373 FRANCE AVE S STE 408, EDINA, MN 55435-4549
(651) 430-3800
(651) 430-3827
Mailing address
1950 NORTHWESTERN AVE S STE 102, STILLWATER, MN 55082-7615
(651) 430-3800
(651) 430-3827
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
47215
MN
207XS0117X
Orthopaedic Surgery of the Spine Physician
MD00049377
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0238823
L & I
WA
01
—
G8876017
MEDICARE POSM
WA
01
—
G8876642
MEDICARE EMRI
WA
01
—
P00689386
MEDICARE RR KING CO.
WA
Enumeration date
05/30/2007
Last updated
01/11/2021
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