Dr. Theodore A. Jackson
Surgeon Plastic Hand Surgeon
1306 Kanawha Blvd E Suite 100
Charleston
, West Virginia 25301-3001
Dr. Theodore A. Jackson
Surgeon Plastic Hand Surgeon
1306 Kanawha Blvd E Suite 100
Charleston
, West Virginia 25301-3001
(304) 346-2271
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About
Features
Specialties
- Surgeon
- Plastic Hand Surgeon
Languages spoken
- English
Location
First Address
- Dr. Theodore A. Jackson
- 1306 Kanawha Blvd E Suite 100
- Charleston, WV
- Zip : 25301-3001
- Fax : (304) 346-2271
- Phone : (304) 342-1113
Second Address
- Dr. Theodore A. Jackson
- 1306 Kanawha Blvd E Suite 100
- Charleston, WV
- Zip : 25301-3001
- Fax : (304) 346-2271
- Phone : (304) 342-1113
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208200000X | Surgeon | 13531 | WV |
| Y | 208600000X | Surgeon | 13531 | WV |
| N | 2082S0105X | Plastic Hand Surgeon | 13531 | WV |
National Provider Identifier
| NPI | 1942294376 |
|---|---|
| Provider Name | Dr. Theodore A. Jackson |
| First Address | Charleston, WV 25301-3001 |
| Second Address | Charleston, WV 25301-3001 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 31/08/2005 |
| Last Update Date | 12/03/2009 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 0051155000 | (05) | WV |
| E39927 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.