Organization
CHARLES W JACKSON MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES JACKSON M.D. (PRESIDENT)
(714) 847-6545
Entity
Organization
Contact information
Practice address
17122 BEACH BLVD, STE. 102, HUNTINGTON BEACH, CA 92647-5992
(714) 847-6545
(714) 847-6547
Mailing address
PO BOX 7630, LAGUNA NIGUEL, CA 92607-7630
(949) 643-3345
(949) 643-3560
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
G35311
CA
Other
Enumeration date
06/06/2007
Last updated
07/28/2010
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