Individual
LAEIA B JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5757 PARK CENTER CT., TOLEDO, OH 43615
(419) 474-4064
(419) 472-2772
Mailing address
5757 PARK CENTER CT., TOLEDO, OH 43615
(419) 474-4064
(419) 472-2772
Taxonomy
Speciality
Code
Description
License number
State
2085R0205X
Radiological Physics Physician
Primary
4301507021
MI
390200000X
Student in an Organized Health Care Education/Training Program
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—
Other
Enumeration date
04/01/2017
Last updated
08/08/2023
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