Provider Demographics
NPI:1346458015
Name:JACKSON, STEVEN B (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:B
Last Name:JACKSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 23RD ST
Mailing Address - Street 2:STE 1000
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1404
Mailing Address - Country:US
Mailing Address - Phone:330-971-7571
Mailing Address - Fax:330-255-5093
Practice Address - Street 1:1900 23RD ST
Practice Address - Street 2:STE 1000
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1404
Practice Address - Country:US
Practice Address - Phone:330-971-7571
Practice Address - Fax:330-255-5093
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34009664207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2999297Medicaid
P00886745Medicare PIN
4280082Medicare PIN