Individual
DR. WILLIAM J JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
148 MIDLAND BLVD, SHELBYVILLE, KY 40065-9734
(502) 647-1958
(502) 647-1940
Mailing address
148 MIDLAND BLVD, SHELBYVILLE, KY 40065-9734
(502) 647-1958
(502) 647-1940
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18425
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000273132
BCBS
KY
05
—
64184252
—
KY
Enumeration date
06/28/2006
Last updated
07/09/2007
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