Larry D. Jackson PA-C
Physician Assistant in Youngstown, OH(View on Map)
Full Name
Larry D Jackson PA-C
NPI Number
1912928441
NPI Type
Individual Provider
Gender
Male
Enumeration Date
07/21/2006
Specialties
(Taxonomies)Code
363A00000X
146D00000X
Primary Taxonomy
Yes
No
Licenses
State
Ohio
Ohio
License Number
50-000351
50000351
Contact
Information
Purpose
Mailing
Location
Address
16620 DOWNEY GLEN TRL
500 GYPSY LN
City
Burton
Youngstown
State
OH
OH
Postal Code
44021-9319
44504-1315
Country
US
US
Telephone Number
N/A
(330) 884-1000
Identifiers
Identifier
970029949
Identifier State
OH
Identifier Issuer
MEDICARE TRAVELERS RR-GA
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 11/20/2014
Provider Address
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