Individual
DR. KENNETH WILLIAM JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12255 FAIR LAKES PARKWAY, FAIRFAX, VA 22033-3952
(703) 934-5905
(703) 934-5778
Mailing address
KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP, 2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANCE UNI, ROCKVILLE, MD 20852-4908
(301) 816-6660
(301) 816-6308
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0101038325
VA
Other
Enumeration date
12/05/2006
Last updated
07/08/2007
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