Active NPI
Robert M Jackson, M.D.
- Otolaryngology/Facial Plastic Surgery Physician
- Lancaster, CA
National Provider Identifier
1982799615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology/Facial Plastic Surgery Physician
- License
- G50418
- Practice address
- 43860 10TH St W Ste 202
Lancaster, CA 93534-4806 - Phone
- (661) 729-4327
- Fax
- (661) 729-4227
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology/Facial Plastic Surgery Physician | 207YX0905X | G50418 | CA | Primary |
Addresses
Primary practice location
43860 10TH St W Ste 202
Lancaster, CA 93534-4806
Mailing address
41250 12TH Street West
Suite C
Palmdale, CA 93551
Phone (661) 224-1300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G50418 | CA | MD | Otolaryngology/Facial Plastic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287360000000",
"number": "1982799615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41250 12TH STREET WEST",
"address_2": "SUITE C",
"city": "PALMDALE",
"state": "CA",
"postal_code": "93551",
"telephone_number": "661-224-1300",
"fax_number": "661-224-1330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "43860 10TH ST W STE 202",
"city": "LANCASTER",
"state": "CA",
"postal_code": "935344806",
"telephone_number": "661-729-4327",
"fax_number": "661-729-4227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ROBERT",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2010-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "207YX0905X",
"taxonomy_group": "",
"desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
"state": "CA",
"license": "G50418",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lancaster, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.