Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 04-2105 | KS |
N | 207X00000X | Orthopaedic Surgeon | 0428105 | KS |
N | 207X00000X | Orthopaedic Surgeon | 118992 | MO |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 04-2105 | KS |
N | 207XS0117X | Orthopaedic Spine Surgeon | 0428105 | KS |
N | 207XS0117X | Orthopaedic Spine Surgeon | 118992 | MO |
NPI | 1174551808 |
---|---|
Provider Name | Dr. Robert Sean Jackson |
First Address | Kansas City, KS 66160-0000 |
Second Address | Kansas City, KS 66160-0000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 23/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1826450 | UNITED HEALTH CARE (01) | |
25755019 | BCBS KC (01) | |
25755019 | BCBS OTHER (01) | |
7665523 | AETNA (01) | |
G75359 | (02) |