Herschel S Jackson Jr., M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

15974 Issued in KY

Practice address

300 S 8TH St
Suite 107#
Murray, KY 42071-2400

Phone

(270) 753-9240

Fax

(270) 767-3629

NPI assigned

Mar 2, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292889600000",
    "number": "1194792796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 S 8TH ST",
            "address_2": "SUITE 107#",
            "city": "MURRAY",
            "state": "KY",
            "postal_code": "420712400",
            "telephone_number": "270-753-9240",
            "fax_number": "270-767-3629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S 8TH ST",
            "address_2": "SUITE 107#",
            "city": "MURRAY",
            "state": "KY",
            "postal_code": "420712400",
            "telephone_number": "270-753-9240",
            "fax_number": "270-767-3629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "HERSCHEL",
        "middle_name": "S",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-02",
        "last_updated": "2010-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "KY",
            "license": "15974",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE ID",
            "identifier": "020006711",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64159742",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM ID",
            "identifier": "000000045254",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Imac Medical of Kentucky PSC
• Intensive Care Experts Health Network LLC
• Cynthia S Ivey, CSFA
• J David Outland, M.D.
• Caitlin Raeann Jackson, PHARMD
• Leanna Marie Jackson, APRN
• James David Jaco, O.D.
• Alycia Christine Janow
• Jarvis Vision Center, PLLC
• Reed Jarvis, O.D.

• Urology Physician in Murray, KY
• Providers in Murray, KY by specialty
• Urology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.