Individual
DR. CHARLES BRADFORD JACKSON
Active
Individual
DR. CHARLES BRADFORD JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
0101024618
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
148958700
WORKSMANS COMP
VA
05
—
6459871
—
VA
01
—
B/C 36190001
BLUE CROSS
VA
01
—
CAREFIRST 3619001
CAREFIRST
VA
Enumeration date
04/07/2006
Last updated
12/08/2011
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