Individual
DR. JAMES M JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
9246 LIGHTWAVE AVE STE 120, SAN DIEGO, CA 92123-6411
(800) 270-5016
(800) 680-3626
Mailing address
9246 LIGHTWAVE AVE STE 120, SAN DIEGO, CA 92123-6411
(800) 270-5016
(800) 680-3626
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G74843
CA
207X00000X
Orthopaedic Surgery Physician
Primary
G74843
CA
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
G74843
CA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
G74843
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G748430
—
CA
01
—
G74843
LICENSE
CA
Enumeration date
10/02/2006
Last updated
04/15/2026
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