Individual
CARRIE ROSE KLOTZ JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
134 HOMER AVE, CORTLAND, NY 13045-1206
(410) 409-5844
Mailing address
134 HOMER AVE, CORTLAND, NY 13045-1206
(410) 409-5844
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
256859
NY
207P00000X
Emergency Medicine Physician
MD0000045187
TN
Other
Enumeration date
06/11/2007
Last updated
10/25/2011
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