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Organization

JACKSON PODIATRY, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DERRICK O JACKSON DPM (PODIATRIST)
(330) 398-3777
Entity
Organization

Contact information

Practice address
1201 BELMONT AVE, YOUNGSTOWN, OH 44504
(330) 333-3365
Mailing address
1201 BELMONT AVE, YOUNGSTOWN, OH 44504-1101
(330) 333-3365

Taxonomy

Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
36003456
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2736098
OH
Enumeration date
06/16/2007
Last updated
12/28/2018
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