Organization
KEITH A JACKSON MD LIMITED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA MARIE BAKER (OFFICE MANAGER)
(858) 279-4221
Entity
Organization
Contact information
Practice address
8010 FROST ST, 503, SAN DIEGO, CA 92123-2778
(858) 279-4221
(858) 279-4223
Mailing address
8010 FROST ST, 503, SAN DIEGO, CA 92123-2778
(858) 279-4221
(858) 279-4223
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G58187
CA
Other
Enumeration date
02/25/2008
Last updated
02/25/2008
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