| NPI | 1306041744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK O JACKSON Podiatrist 330-398-3777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: OH 36003456) |
| Enumeration Date | 2007-06-16 |
| Last Update Date | 2018-12-28 |