Individual
HERSCHEL S JACKSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 S 8TH ST, SUITE 107#, MURRAY, KY 42071-2400
(270) 753-9240
(270) 767-3629
Mailing address
300 S 8TH ST, SUITE 107#, MURRAY, KY 42071-2400
(270) 753-9240
(270) 767-3629
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
15974
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000045254
ANTHEM ID
KY
01
—
020006711
RAILROAD MEDICARE ID
KY
05
—
64159742
—
KY
Enumeration date
03/02/2006
Last updated
12/21/2010
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