Individual
RUSSELL RAYMOND JAICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
720 W OAK ST, SUITE 101, KISSIMMEE, FL 34741-4989
(407) 846-3166
Mailing address
720 W OAK ST, STE 101, KISSIMMEE, FL 34741-4989
(407) 846-3166
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME113621
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
28788834
—
CO
Enumeration date
09/05/2006
Last updated
04/18/2013
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