Jackson, James D

Jackson, James D is an individual health care provider with primary practice located at 2215 Portland Ave , Louisville KY 40212-1033. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Jackson, James D can be contacted via phone (502) 774-8631.

Contact Information

Primary practice address
2215 Portland Ave Louisville KY 40212-1033
Phone: (502) 774-8631
Fax: (502) 776-8912
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 26050 Kentucky

Profile Details

NPI number 1235135039
LBN Legal business name Jackson, James D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 27th, 2005
Last updated Apr 15th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235135039 NPPES
Kentucky MEDICAID 64873052

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