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Organization
SOUTHEAST MOBILE ANESTHESIA LLC
Active
Organization
SOUTHEAST MOBILE ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK JACKSON MD (PRESIDENT)
(859) 409-2022
Entity
Organization
Contact information
Practice address
1727 COACHTRAIL DR, HEBRON, KY 41048-8476
(859) 409-2022
(513) 332-9225
Mailing address
1727 COACHTRAIL DR, HEBRON, KY 41048-8476
(859) 409-2022
(513) 332-9225
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
40009
KY
Other
Enumeration date
03/26/2010
Last updated
03/26/2010
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