Individual
DR. STEPHEN H JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
510 LINCOLN DR, HERRIN, IL 62948-6334
(618) 997-6800
(618) 998-9635
Mailing address
4787 ALBEN BARKLEY DRIVE, PADUCAH, KY 42002
(270) 442-9461
(270) 441-0079
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
24187
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64241870
—
KY
Enumeration date
08/24/2006
Last updated
10/23/2015
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