MR. BRUCE L JACKSON (NPI# 1124072087) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1124072087 |
Entity Type | Individual |
Full Name | MR. BRUCE L JACKSON |
Credential | P.A. |
Practice Address |
15863 Kasota Rd Apple Valley CA 92307-4507 |
Mailing Address |
11919 Hesperia Rd Hesperia CA 92345-1855 |
Practice Telephone | 7609481454 |
Practice Fax Number | 7609486100 |
Mailing Telephone | 7609481454 |
Mailing Fax Number | 7609486100 |
Enumeration Date | 2006-05-22 |
Last Update Date | 2007-07-08 |
Gender Code | M |
Is Sole Proprietor | X |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA14185 | CA | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
CA | GR0050902 | 05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1992039291 | Bruce C. Jackson | Chiropractor | 201 Brighton Park Blvd., Ste. 4, Frankfort, KY 40601-8447 | 2009-09-21 |
1851430532 | Bruce W Jackson | Dentist | 111 Lilac Dr, Liberal, KS 67901 | 2007-02-06 |
1598133571 | Bruce Jackson | Registered Nurse | 2828 1st Ave Ste 400, Huntington, WV 25702-1236 | 2015-09-09 |
1467711986 | Bruce Jackson | Case Manager/Care Coordinator | 5715 S Broadway, Los Angeles, CA 90037-4131 | 2012-05-04 |
1598819567 | Bruce E Jackson | Counselor | 5455 Almira Dr Se, Bremerton, WA 98311-8330 | 2007-01-23 |
1609883438 | Bruce K Jackson | Internal Medicine | 520 N Prospect Ave, Ste. 300, Redondo Beach, CA 90277-3041 | 2006-08-02 |
1720039878 | Bruce Arden Jackson II | Dentist | 4829 E Beltline Ave Ne, Grand Rapids, MI 49525-9747 | 2006-05-13 |
Street Address |
15863 KASOTA RD |
City | APPLE VALLEY |
State | CA |
Zip Code | 92307-4507 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1316204241 | Afp Drugstore, Inc. | Pharmacy | 15863 Kasota Rd, Suite C, Apple Valley, CA 92307-4507 | 2012-04-17 |
1073647269 | Desert Family Practice Associates | Family Medicine | 15863 Kasota Rd, Apple Valley, CA 92307-4507 | 2007-03-16 |
1114037942 | Afp Drug Store Inc | Pharmacy | 15863 Kasota Rd, Ste C, Apple Valley, CA 92307-4507 | 2006-08-30 |
1154375053 | Craig R Mueller | Family Medicine | 15863 Kasota Rd, Apple Valley, CA 92307-4507 | 2006-05-22 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1679106025 | Rajender S. Thakran, M.d., Inc | Specialist | 16030 Kamana Rd, Apple Valley, CA 92307 | 2020-02-13 |
1477119980 | Harpreet Singh | Nurse Practitioner | 18300 Ca-18, Apple Valley, Ca 92307, Apple Valley, CA 92307 | 2019-05-10 |
1184120784 | Frantz Jean-louis | Nurse Practitioner | 16134 Muni Rd, Apple Valley, CA 92307 | 2018-04-03 |
1053862078 | Ashley M Morello | Registered Nurse | Universal Pain Management, 16179 Siskiyou, Apple Valley, CA 92307 | 2016-10-14 |
1891191680 | Ann Simonds | Marriage & Family Therapist | 20601 Us Highway 18 Ste 123, Apple Valley, CA 92307 | 2014-11-06 |
1396147419 | Aaa Family Medical Group | Family Medicine | 15995 Tuscola Rd Ste 202, Apple Valley, CA 92307 | 2014-09-19 |
1659780534 | Relena Tran | Pharmacist | 20251 Highway 18, Apple Valley, CA 92307 | 2014-08-05 |
1639508526 | Meagan Katherine Blades | Physician Assistant | 18300 Outer Hwy 18, Apple Valley, CA 92307 | 2013-11-01 |
1720341555 | Jonathan Robert Cox | Dermatology | 18523 Corwin Rd Ste G, Apple Valley, CA 92307 | 2012-06-18 |
1821364365 | Leary Sport and Spine Chiropractic Inc. | Chiropractor | 18564 Us Highway 18 Suite, 303, Apple Valley, CA 92307 | 2012-03-29 |
Find all providers in zip 92307 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1144780016 | Lauren Nicole Smith | Physician Assistant | 18112 Outer Hwy 18 Ste 101, Apple Valley, CA 92307-2211 | 2019-03-25 |
1275979742 | Michelle A. Oropeza | Physician Assistant | 18112 Outer Hwy 18, Suite 101, Apple Valley, CA 92307-2211 | 2013-05-10 |
1639220080 | Michelle Ann Wanner | Physician Assistant | 15115 Dove Trl, Attn: Minuteclinic, Apple Valley, MN 55124-7871 | 2007-01-14 |
1265469712 | William Joseph Wilson | Physician Assistant | 18522 Highway 18, Suite 102, Apple Valley, CA 92307 | 2006-06-27 |
1053369009 | Michael S Erskine | Physician Assistant | 16003 Tuscola Rd, Suite F, Apple Valley, CA 92307-1319 | 2006-05-04 |
1790315273 | Sarah Barnes | Physician Assistant | 14655 Galaxie Ave, Apple Valley, MN 55124-8602 | 2020-01-23 |
1801433305 | Vishal Verma | Physician Assistant | 19341 Bear Valley Rd Ste 101, Apple Valley, CA 92308-5152 | 2019-12-03 |
1235697376 | Elias Christopher Frangos | Physician Assistant | 15962 Quantico Rd, Apple Valley, CA 92307-1302 | 2019-03-07 |
1184122046 | Daniel Joseph Lunsford Durbin | Physician Assistant | 7300 147th St W Ste 204, Apple Valley, MN 55124-7850 | 2018-01-25 |
1194253377 | Paul Sangwook Rhee | Physician Assistant | 18300 Us Highway 18, Apple Valley, CA 92307-2206 | 2017-05-31 |
Find all providers in APPLE VALLEY |
City | APPLE VALLEY |
Zip Code | 92307 |
Please comment or provide details below to improve the information on MR. BRUCE L JACKSON.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.