Individual
DR. KEITH WAYNE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
235 N HOOVER ST, LOS ANGELES, CA 90004-3627
(949) 707-5339
Mailing address
25108 MARGUERITE PKWY, SUITE A 203, MISSION VIEJO, CA 92692-2400
(949) 707-5339
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G46539
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G465391
—
CA
Enumeration date
03/05/2007
Last updated
07/08/2007
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