Individual
DAVID JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1044 BELMONT AVE, YOUNGSTOWN, OH 44504-1006
(330) 746-7211
(330) 656-5901
Mailing address
5700 DARROW RD, SUITE 106, HUDSON, OH 44236-5021
(330) 656-5911
(330) 656-5901
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35059981J
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001474708-0001
PENNSYLVANIA MEDICAID
OH
05
—
0805230
—
OH
01
—
700007026
RAILROAD MEDICARE
OH
01
—
P00360149
RAILROAD MEDICARE
OH
Enumeration date
12/15/2005
Last updated
07/25/2019
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