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Contact Information

KEITH A JACKSON, MD
5405 OBERLIN DR FL 2
SAN DIEGO, CA92121-1700
 Phone: 858-909-0770
 Fax: 858-909-0880
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Otolaryngology

207Y00000X 04 Physician/Otolaryngology
 

Otology & Neurotology

207YX0901X 04 Physician/Otolaryngology
Indicates primary specialty

NPI Profile & details for KEITH A JACKSON · (Male)

NPI # 1124091970
Status Active
Credentials MD
Entity Individual
Enumeration date 02/10/2006
Last updated 01/25/2024 - About 2 years ago
Sole proprietor 1 Yes
Identifiers
  • CA License # G58187
  • NV License # 8547
  • NV Medicaid 002018083
Hospital affiliation(s)
  • SHARP CORONADO HOSPITAL AND HLTHCR CTR - (Acute Care)
    250 PROSPECT PLACE
    CORONADO, CA 92118
  • SHARP MEMORIAL HOSPITAL - (Acute Care)
    7901 FROST ST
    SAN DIEGO, CA 92123
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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