Provider Demographics
NPI:1396027041
Name:PAXSON, JACINDA L (DO)
Entity Type:Individual
Prefix:
First Name:JACINDA
Middle Name:L
Last Name:PAXSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 27TH ST
Mailing Address - Street 2:WALLER BUILDING, SUITE B06
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2677
Mailing Address - Country:US
Mailing Address - Phone:740-356-8051
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:1735 27TH ST
Practice Address - Street 2:WALLER BUILDING, SUITE B06
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2677
Practice Address - Country:US
Practice Address - Phone:740-356-8051
Practice Address - Fax:740-353-7900
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58003973207Q00000X
OH34.101815207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine