Individual
JAMES W JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
120 EXECUTIVE PARK, LOUISVILLE, KY 40207
(502) 855-7200
(502) 855-7201
Mailing address
PO BOX 21890, BELFAST, ME 04915-4115
(502) 907-0356
(502) 919-9780
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
01062749A
IN
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
41100
KY
208VP0014X
Interventional Pain Medicine Physician
41100
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000858929
ANTHEM PIN
—
01
—
002903176
UNITED HEALTHCARE PROVIDER ID NUMBER
—
01
—
135386KYIP
AETNA BETTER HEALTH OF KY PROVIDER ID NUMBER
KY
05
—
200872860
—
IN
05
—
7100003940
—
KY
01
—
719905
WELLCARE OF KY PROVIDER ID
KY
01
—
9121168
AETNA PIN
—
01
—
CS1434500725
CARESOURCE ID
—
Enumeration date
11/11/2006
Last updated
06/09/2022
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