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NPI Code Detail

MEDICARE: JAY SAMUEL JACKSON DO

MEDICARE: JAY SAMUEL JACKSON DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1255273470
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAY SAMUEL JACKSON DO
Provider Business Mailing Address
First Line : 1100 DELAPLAINE CT
Second Line :
City : MADISON
State : WI
Zip : 53715-1840
Country : US
Telephone Number : 608-263-4550
Fax Number :
Provider Business Practice Location Address
First Line : 1700 TUTTLE ST
Second Line :
City : BARABOO
State : WI
Zip : 53913-3319
Country : US
Telephone Number : 608-355-3800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2026
Last Update Date : 04/07/2026

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Directions to “ JAY SAMUEL JACKSON DO” Practice Location

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