LYLE THOMAS JACKSON JR. (NPI# 1144540790) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144540790 |
| Entity Type | Individual |
| Full Name | LYLE THOMAS JACKSON JR. |
| Credential | M.D. |
| Practice Address |
55 Coburg Rd Eugene OR 97401-2433 |
| Practice Telephone | 5414858111 |
| Mailing Telephone | 5414858111 |
| Mailing Fax Number | 5413426379 |
| Enumeration Date | 2010-06-06 |
| Last Update Date | 2020-07-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | 16057 | NV | Allopathic & Osteopathic Physicians |
| N | 207X00000X | Orthopaedic Surgery | 32738 | SC | Allopathic & Osteopathic Physicians |
| Y | 207XX0004X |
Orthopaedic Surgery Specialization: Foot and Ankle Surgery |
MD176209 | OR | Allopathic & Osteopathic Physicians |
| N | 207XX0004X |
Orthopaedic Surgery Specialization: Foot and Ankle Surgery |
16057 | NV | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 555 N Arlington Ave, Reno, NV 895034723 | 7757863040 | 7757861358 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225597305 | Lyle Jeremy Jackson | Nurse Anesthetist, Certified Registered | 1001 Sam Perry Blvd, Fredericksburg, VA 22401-4453 | 2019-03-18 |
| Street Address |
55 COBURG RD |
| City | EUGENE |
| State | OR |
| Zip Code | 97401-2433 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639176480 | Stanley L James | Orthopaedic Surgery | 55 Coburg Rd, Eugene, OR 97401-2433 | 2005-07-07 |
| 1922624741 | Amelia T Devereaux | Specialist/Technologist, Other | 55 Coburg Rd, Eugene, OR 97401-2433 | 2020-06-17 |
| 1437615499 | Kymry Scott | Nurse Practitioner | 55 Coburg Rd, Eugene, OR 97401-2433 | 2019-02-14 |
| 1235606534 | Zachary Austin Roth | Orthopaedic Surgery | 55 Coburg Rd, Eugene, OR 97401-2433 | 2018-10-25 |
| 1720565484 | Jessica Lee Cline | Occupational Therapist | 55 Coburg Rd, Eugene, OR 97401-2433 | 2018-07-25 |
| 1073039277 | Steven M Robert | Physical Medicine & Rehabilitation | 55 Coburg Rd, Eugene, OR 97401-2433 | 2017-08-18 |
| 1073041398 | Darby Stark | Registered Nurse | 55 Coburg Rd, Eugene, OR 97401-2433 | 2017-05-31 |
| 1821537408 | Jason Timothy Queer | Physician Assistant | 55 Coburg Rd, Eugene, OR 97401-2433 | 2017-02-16 |
| 1932659992 | John Stanievich Jr. | Physician Assistant | 55 Coburg Rd, Eugene, OR 97401-2433 | 2016-10-13 |
| 1700236692 | Luke Seidel | Specialist | 55 Coburg Rd, Eugene, OR 97401-2433 | 2016-06-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427681709 | Sarah Voigt | Counselor | 2149 Centennial Plaza Suite #4, Eugene, OR 97401 | 2020-02-14 |
| 1801426242 | Therapeutic Associates, Inc. | Physical Therapist | 760 Charnelton St., Suite 760, Eugene, OR 97401 | 2020-01-24 |
| 1225676232 | Aaron James Barber | Massage Therapist | 1375 Pearl St, Eugene, Or 97401, Eugene, OR 97401 | 2019-12-20 |
| 1851957047 | Altru Home Care LLC | Nursing Care | 1345 Olive St., Eugene, OR 97401 | 2019-05-14 |
| 1881155208 | Herron Jordanna Spence | Speech-Language Pathologist | 385 West 2nd Ave., Eugene, OR 97401 | 2019-03-28 |
| 1750855094 | Brandon Marshall | Counselor | 1158 High St Ste 202, Eugene, OR 97401 | 2019-01-21 |
| 1881172591 | Kayla Nicole O'brien | Nurse Practitioner | Country Club In Eugene, 520 Country Club Road, Eugene, OR 97401 | 2018-08-03 |
| 1962992180 | Shannon Jensen Smyth | Counselor | Va Eugene Downtown Clinic, 211 E. 7th Ave, Eugene, OR 97401 | 2018-05-14 |
| 1902305956 | Christine Noel Gray | Peer Specialist | 499 W. 4th Ave, Eugene, OR 97401 | 2018-02-06 |
| 1821507344 | Anjuli Chitkara | Psychologist | 1679 Willamette Street, Eugene, OR 97401 | 2017-09-27 |
| Find all providers in zip 97401 | ||||
| Taxonomy Code | 207XX0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Foot and Ankle Surgery |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, foot and ankle surgeons deal with adult reconstructive foot and ankle surgery, adult foot and ankle trauma, sports medicine foot and ankle, and children's foot and ankle reconstructive surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: title modified, definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. ACGME Accredited Residency Program Requirements: 1 year of training with 5 years Orthopedic Surgery for a total of 6 years. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093014771 | Akash Gupta | Orthopaedic Surgery | 6542 Se Lake Rd Ste 201, Milwaukie, OR 97222-2245 | 2011-03-21 |
| 1346366523 | Natalie Squires Mesnier | Orthopaedic Surgery | 5050 Ne Hoyt St Ste 626, Portland, OR 97213-2956 | 2007-03-21 |
| 1770581415 | Jeffrey Arthur Holmboe | Orthopaedic Surgery | 1303 Ne Cushing Dr, Ste 100, Bend, OR 97701-3887 | 2005-07-07 |
| 1477105278 | Akash Gupta Md PC | Orthopaedic Surgery | 6542 Se Lake Rd Ste 201, Milwaukie, OR 97222-2245 | 2019-07-11 |
| 1225567928 | Eastside Orthopedics & Sports Medicine, LLC | Orthopaedic Surgery | 6542 Se Lake Rd Ste 201, Milwaukie, OR 97222-2245 | 2017-06-06 |
| 1942611025 | Bopha Chrea | Orthopaedic Surgery | 3181 Sw Sam Jackson Park Rd # Op31, Portland, OR 97239-3011 | 2014-05-12 |
| 1366718116 | Lara Chamberlain Atwater | Orthopaedic Surgery | 3181 Sw Sam Jackson Park Rd # Op31, Portland, OR 97239-3011 | 2012-03-27 |
| 1558533273 | Adam Parks Baker | Orthopaedic Surgery | 10000 Se Main St Ste 224, Portland, OR 97216-2469 | 2008-04-02 |
| 1285683656 | Orthopedic & Fracture Clinic PC | Orthopaedic Surgery | 11782 Sw Barnes Rd, Suite 300, Portland, OR 97225-5914 | 2006-05-10 |
| 1508855818 | John-paul Veri | Orthopaedic Surgery | 2780 E Barnett Rd, Suite 200, Medford, OR 97504-8343 | 2005-10-19 |
| Find all providers with the same taxonomy | ||||
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| 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.