Individual
JAMES D JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2215 PORTLAND AVE, LOUISVILLE, KY 40212-1033
(502) 774-8631
(502) 776-8912
Mailing address
PO BOX 950244, LOUISVILLE, KY 40295-0244
(502) 953-4700
(502) 776-8912
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
26050
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64873052
—
KY
Enumeration date
06/27/2005
Last updated
04/15/2021
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