Individual
CHARLES G JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 112TH AVE NE, SUITE C-210, BELLEVUE, WA 98004-3732
(425) 454-2191
(425) 453-1270
Mailing address
PO BOX 632, AUBURN, WA 98071-0632
(425) 454-2191
(425) 453-1270
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
MD00014267
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1039247
—
WA
Enumeration date
07/27/2006
Last updated
07/07/2009
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