Provider Demographics
NPI:1578728614
Name:JACKSON, KEITH LYNN II (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:LYNN
Last Name:JACKSON
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:2222 N NEVADA AVE STE 5001
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6865
Mailing Address - Country:US
Mailing Address - Phone:719-776-3580
Mailing Address - Fax:719-776-3599
Practice Address - Street 1:2222 N NEVADA AVE STE 5001
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6865
Practice Address - Country:US
Practice Address - Phone:719-776-3580
Practice Address - Fax:719-776-3599
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0059249207XS0117X
NC2014-01633207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine