Provider Demographics
NPI:1902996895
Name:JACKSON, J. CRAIG (MD)
Entity type:Individual
Prefix:DR
First Name:J. CRAIG
Middle Name:
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 SAND POINT WAY NE
Mailing Address - Street 2:SEATTLE CHILDREN'S HOSPITAL FA-2
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3900
Mailing Address - Country:US
Mailing Address - Phone:206-987-2532
Mailing Address - Fax:206-987-2685
Practice Address - Street 1:4500 SAND POINT WAY NE
Practice Address - Street 2:SEATTLE CHILDREN'S HOSPITAL FA-2
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3900
Practice Address - Country:US
Practice Address - Phone:206-987-2532
Practice Address - Fax:206-987-2685
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000183632080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8366502Medicaid
2266OtherINTERNAL ID-MOTOR VEHICLE ID
WA8366502Medicaid
E42372Medicare UPIN