Provider Demographics
NPI:1376542951
Name:JACKSON, JAMES LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEE
Last Name:JACKSON
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 1:101 MEDICAL HEIGHTS DR
Mailing Address - Street 2:SUITE M
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4137
Mailing Address - Country:US
Mailing Address - Phone:502-227-7538
Mailing Address - Fax:502-227-9248
Practice Address - Street 1:101 MEDICAL HEIGHTS DR
Practice Address - Street 2:SUITE M
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4137
Practice Address - Country:US
Practice Address - Phone:502-227-7538
Practice Address - Fax:502-227-9248
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23520207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1376542951OtherRAILROAD MEDICARE
KYC30629OtherRAILROAD MEDICARE
KY64235203Medicaid
KY000000048738OtherANTHEM BCBS
KY65934895Medicaid
KY1376542951OtherRAILROAD MEDICARE
KY64235203Medicaid
KY0212204Medicare PIN