Provider Demographics
NPI:1174551808
Name:JACKSON, ROBERT SEAN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SEAN
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SEAN
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3901 RAINBOW BLVD,
Mailing Address - Street 2:MS#3017 UNIVERSITY OF KANSAS MEDICAL CENTER
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0000
Mailing Address - Country:US
Mailing Address - Phone:913-588-6100
Mailing Address - Fax:913-588-8186
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:UNIVERSITY OF KANSAS MEDICAL CENTER
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0000
Practice Address - Country:US
Practice Address - Phone:913-588-6100
Practice Address - Fax:913-588-8186
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-2105207X00000X, 207XS0117X
MO118992207X00000X, 207XS0117X
KS0428105207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
25755019OtherBCBS KC
1826450OtherUNITED HEALTH CARE
25755019OtherBCBS OTHER
7665523OtherAETNA
200035390Medicare ID - Type UnspecifiedRR MEDICARE
KS0447460003Medicare NSC
25755019OtherBCBS KC
MO1159930Medicare PIN
7665523OtherAETNA
G75359Medicare UPIN