Provider Demographics
NPI:1982185443
Name:JACKSON, CHRISTOPHE EUGENE (PHD, MSPAS, PA-C)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHE
Middle Name:EUGENE
Last Name:JACKSON
Suffix:
Gender:M
Credentials:PHD, MSPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10099 RIDGEGATE PKWY STE 480
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5537
Mailing Address - Country:US
Mailing Address - Phone:720-599-3074
Mailing Address - Fax:720-360-1195
Practice Address - Street 1:10099 RIDGEGATE PKWY STE 480
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5537
Practice Address - Country:US
Practice Address - Phone:720-599-3074
Practice Address - Fax:720-360-1195
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA808272084A2900X
COPA00061792084A2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical CareGroup - Single Specialty