Provider Demographics
NPI:1174678312
Name:DEMPSEY, JACKSON T (MD)
Entity Type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:T
Last Name:DEMPSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 S CENTRAL AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-7274
Mailing Address - Country:US
Mailing Address - Phone:541-646-8382
Mailing Address - Fax:541-482-4841
Practice Address - Street 1:328 S CENTRAL AVE
Practice Address - Street 2:STE 206
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7274
Practice Address - Country:US
Practice Address - Phone:541-890-6841
Practice Address - Fax:541-482-4841
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD159462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E83412Medicare UPIN
ORR115288Medicare PIN