Individual
DR. GLENNA S JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3780 MEDINA RD, STE. 310, MEDINA, OH 44256-9311
(330) 725-8441
(330) 725-8442
Mailing address
3780 MEDINA RD, STE. 310, MEDINA, OH 44256-9311
(330) 725-8441
(330) 725-8442
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35060413
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080119109
RAILROAD MEDICARE
OH
05
—
825601
—
OH
Enumeration date
01/30/2006
Last updated
08/15/2011
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