Individual
DR. SHAWN IAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1947 N FOUNDERS CIR, WCGME, WICHITA, KS 67206-3548
(316) 613-4930
Mailing address
1947 N FOUNDERS CIR, WCGME, WICHITA, KS 67206-3548
(316) 613-4930
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
04-33385
KS
207R00000X
Internal Medicine Physician
04-33385
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200656050A
—
KS
Enumeration date
06/15/2007
Last updated
12/01/2014
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