Organization
BLAINE K. JACKSON, M.D., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BLAINE K JACKSON M.D. (OWNER)
(858) 259-9708
Entity
Organization
Contact information
Practice address
530 LOMAS SANTA FE DR, SUITE M, SOLANA BEACH, CA 92075-1349
(858) 259-9708
(858) 259-9689
Mailing address
530 LOMAS SANTA FE DR, SUITE M, SOLANA BEACH, CA 92075-1349
(858) 259-9708
(858) 259-9689
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A67288
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A672881
—
CA
Enumeration date
08/12/2008
Last updated
08/12/2008
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