Provider Demographics
NPI:1861610727
Name:JACKSON, JAMES KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KENNETH
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 1:1590 EAST 13TH ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403
Mailing Address - Country:US
Mailing Address - Phone:541-346-4441
Mailing Address - Fax:
Practice Address - Street 1:1590 E 13TH ST.
Practice Address - Street 2:UNIVERSITY HEALTH CENTER
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403
Practice Address - Country:US
Practice Address - Phone:541-346-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine