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General NPI Number Information
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NPI Number | 1063583268
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Entity Type | Individual
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Provider Name | JAMES W JACKSON JR. MD
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Gender | Male
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Dates
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Enumeration Date | 11/11/2006
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 120 EXECUTIVE PARK
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City | LOUISVILLE
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State | KY
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Zip | 40207
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Country | US
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Telephone | 502-855-7200
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Fax | 502-855-7201
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Provider Business Mailing Address
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Address Line | PO BOX 21890
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City | BELFAST
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State | ME
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Zip | 04915-4115
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Country | US
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Telephone | 502-907-0356
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Fax | 502-919-9780
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 01062749A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 41100
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 41100
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License Number State | KY
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