Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 225159 | MA |
Y | 2080P0210X | Pediatric Nephrologist | MD60002199 | WA |
N | 2080P0216X | Pediatric Rheumatologist | MD60002199 | WA |
NPI | 1780845818 |
---|---|
Provider Name | Dr. Shaun William Jackson |
First Address | Seattle, WA 98105-3901 |
Second Address | Seattle, WA 98105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2008 |
Last Update Date | 27/06/2018 |