Provider Demographics
NPI:1538370846
Name:JACKSON-JOHNSON, SHA-RON (MD)
Entity type:Individual
Prefix:
First Name:SHA-RON
Middle Name:
Last Name:JACKSON-JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHA-RON
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7895 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6665
Mailing Address - Country:US
Mailing Address - Phone:219-947-1910
Mailing Address - Fax:219-947-3117
Practice Address - Street 1:101 E 87TH AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7335
Practice Address - Country:US
Practice Address - Phone:219-769-2041
Practice Address - Fax:219-769-2313
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57010730208600000X
OH35 1234532086S0127X
IN01076732A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery