Provider Demographics
NPI:1154361699
Name:JACKSON, DON V JR (MD)
Entity type:Individual
Prefix:
First Name:DON
Middle Name:V
Last Name:JACKSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-5616
Mailing Address - Fax:828-650-8076
Practice Address - Street 1:80 DOCTORS DR STE 1
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-7289
Practice Address - Country:US
Practice Address - Phone:828-654-0073
Practice Address - Fax:828-681-5036
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC22746207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP01216267OtherMEDICARE RR
NC2359217OtherCIGNA
NC4375905OtherAETNA
NC8945512Medicaid
NC4375905OtherAETNA
C84687Medicare UPIN
NCP01216267OtherMEDICARE RR