Individual
JAMES MARK JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
501 S 2ND ST, LOUISVILLE, KY 40202-1864
(502) 583-7546
(502) 589-3429
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(866) 630-9882
(920) 682-5810
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
01085873A
IN
207N00000X
Dermatology Physician
Primary
31633
KY
207N00000X
Dermatology Physician
J8602
TX
Other
Enumeration date
06/09/2005
Last updated
09/17/2021
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