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Organization

DAVID L. JACKSON, M.D., PSC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DAVID L. JACKSON M.D. (PRESIDENT)
(859) 367-7110
Entity
Organization

Contact information

Practice address
2050 VERSAILLES RD, LEXINGTON, KY 40504-1405
(859) 367-7110
(859) 367-7138
Mailing address
2050 VERSAILLES RD, LEXINGTON, KY 40504-1405
(859) 367-7110
(859) 367-7138

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
24005
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000050829
ANTHEM B/C & B/S PIN
KY
01
2300002
UNITED HEALTHCARE PIN
KY
05
65925463
KY
01
C66084
BLUEGRASS FAMILY HEALTH
KY
Enumeration date
07/12/2005
Last updated
02/03/2009
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