Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | DR.0050426 | CO |
N | 111NI0900X | Internist | DR.0050426 | CO |
N | 208000000X | Pediatrician | DR.0050426 | CO |
Y | 2080P0203X | Pediatric Critical Care Doctor | DR.0050426 | CO |
NPI | 1013159664 |
---|---|
Provider Name | Brian Michael Jackson |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2009 |
Last Update Date | 09/11/2021 |