Individual
CHARLES JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
820 N DALMONT ST, HOBBS, NM 88240-5214
(505) 393-9137
(505) 391-3977
Mailing address
820 N DALMONT ST, HOBBS, NM 88240-5214
(505) 393-9137
(505) 391-3977
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
1640
TX
213E00000X
Podiatrist
Primary
239
NM
213E00000X
Podiatrist
80171
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
67753
—
NM
01
—
NM005310
BCBS
NM
Enumeration date
01/19/2007
Last updated
03/06/2012
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