Individual
ELMER H JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
217 S 3RD ST, DANVILLE, KY 40422-1823
(859) 239-1220
(859) 239-6719
Mailing address
PO BOX 3361, SOMERSET, KY 42564-3361
(865) 766-8818
(865) 766-8825
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
15266
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000063422
BCBS GROUP
KY
05
—
64152663
—
KY
Enumeration date
04/08/2006
Last updated
11/30/2011
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