Individual
KEVIN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
6780 MAYFIELD RD, MAYFIELD HEIGHTS, OH 44124-2203
(440) 312-4500
Mailing address
911 NORTHBORO DR, MAYFIELD VILLAGE, OH 44143-3429
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
67.000265
OH
Other
Enumeration date
10/21/2015
Last updated
10/21/2015
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