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Contact Information

BRIAN G JACKSON, PAC
509 MAIN STREET
LA JARA, CO81140
 Phone: 719-376-2308
 Fax: 719-376-2395
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for BRIAN G JACKSON · (Male)

NPI Number 1245261064
Status Active
Credentials PAC
Entity Individual
Enumeration date 07/06/2006
Last updated 05/06/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • CO License # 843
  • CO Medicaid 07008436
Hospital affiliation(s)
  • SAN LUIS VALLEY HEALTH CONEJOS COUNTY HOSPITAL - (Critical Access)
    19021 US HWY 285
    LA JARA, CO 81140
  • SAN LUIS VALLEY REGIONAL MEDICAL CENTER - (Acute Care)
    106 BLANCA AVE
    ALAMOSA, CO 81101
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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