| Organization Name: | CHARLES W JACKSON MD INC |
| NPI Number: | 1851594006 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES JACKSON (PRESIDENT) |
| Mailing Address: | 17122 Beach Blvd Ste. 102 Huntington Beach |
| State: | CA US |
| Postal Code: | 926475992 |
| Phone Number: | 7148476545 |
| Fax Number: | 7148476547 |
| NPI Enumeration Date: | 06/06/2007 |
| NPI Last Update Date: | 07/28/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | G35311 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |