Organization
ROBERT M JACKSON, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUDY ANN JACKSON (OFFICE MANAGER)
(661) 224-1300
Entity
Organization
Contact information
Practice address
41250 12TH ST W STE C, PALMDALE, CA 93551-1444
(661) 224-1300
(661) 224-1333
Mailing address
41250 12TH ST W STE C, PALMDALE, CA 93551-1444
(661) 224-1300
(661) 224-1333
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
G50418
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W14331
MEDICARE ID
CA
Enumeration date
02/13/2015
Last updated
02/13/2015
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