Individual
EKAETE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
754 S CLEVELAND AVE, #300, MOGADORE, OH 44260-2200
(330) 628-2686
(330) 628-0828
Mailing address
754 S CLEVELAND AVE, #300, MOGADORE, OH 44260-2200
(330) 628-2686
(330) 628-0828
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-123871
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0104794
—
OH
01
—
1841239274
PARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH
01
—
2551671
PARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH
01
—
9338635
PARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH
Enumeration date
08/26/2009
Last updated
12/04/2014
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