Individual
JACK RAYMOND ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1730 W 25TH ST, CLEVELAND, OH 44113-3108
(216) 903-7287
Mailing address
1730 W 25TH ST, CLEVELAND, OH 44113-3108
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
50.005645RX
OH
Other
Enumeration date
12/18/2018
Last updated
12/18/2018
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