Individual
MORRIS B JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3920 S DUPONT SQ STE C, LOUISVILLE, KY 40207-4615
(812) 282-3899
(812) 282-4172
Mailing address
101 HOSPITAL BLVD, JEFFERSONVILLE, IN 47130-3769
(812) 282-3899
(812) 282-4172
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
01039636A
IN
208800000X
Urology Physician
Primary
22181
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00895267
RAILROAD MEDICARE
KY
05
—
201028460
—
IN
05
—
64221815
—
KY
01
—
P00314088
RAILROAD MEDICARE
KY
Enumeration date
05/03/2006
Last updated
01/29/2016
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