MEDICARE: MORRIS B JACKSON MD

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
1	208800000X	Urology Physician	22181	KY
2	208800000X	Urology Physician	01039636A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00314088	OTHER	KY	RAILROAD MEDICARE
4	00895267	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477511921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORRIS B JACKSON MD

Provider Business Mailing Address
First Line	:	101 HOSPITAL BLVD
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3769
Country	:	US
Telephone Number	:	812-282-3899
Fax Number	:	812-282-4172

Provider Business Practice Location Address
First Line	:	3920 S DUPONT SQ STE C
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4615
Country	:	US
Telephone Number	:	812-282-3899
Fax Number	:	812-282-4172

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	01/29/2016

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Directions to “ MORRIS B JACKSON MD” Practice Location

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