Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0204X | Pediatric Emergency Doctor | 4757219-1205 | UT |
Y | 2080P0204X | Pediatric Emergency Doctor | C149126 | CA |
NPI | 1235210022 |
---|---|
Provider Name | Geoffrey Alan Jackman |
First Address | San Diego, CA 92123-4223 |
Second Address | San Diego, CA 92123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 22/08/2017 |