Individual
JAMES W JACKSON
Active
Individual
JAMES W JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01021515
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000210998
ANTHEM BCBS
IN
01
—
060055388
MEDICARE RAILROAD
—
01
—
1096355
PASSPORT KY MEDICAID
KY
05
—
200149120A
—
IN
01
—
2436127000
PASSPORT ADVANTAGE
KY
01
—
5412546
AETNA
—
05
—
64337330
—
KY
Enumeration date
06/28/2006
Last updated
04/22/2008
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