Individual
LAURA K JACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2933 BRECKENRIDGE LN STE 103, LOUISVILLE, KY 40220-1408
(502) 394-5678
(502) 394-5600
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 588-9490
(502) 272-5339
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
37525
KY
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
37525
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200397730
—
IN
05
—
64052772
—
KY
Enumeration date
04/19/2006
Last updated
09/23/2022
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