Most Relevant Information
Provider Data
| NPI Number: | 1003348673 |
| Provider Name: | LAEIA B JACKSON MD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/01/2017 |
| Last Updated: | 08/08/2023 |
Provider Practice Location
5757 PARK CENTER CT.
TOLEDO
OH
43615
Practice Location Phone/Fax
| Phone: | 4194744064 |
| Fax: | 4194722772 |
Provider Mailing Location
5757 PARK CENTER CT.
TOLEDO
OH
43615
Provider Mailing Phone/Fax
| Phone: | 4194744064 |
| Fax: | 4194722772 |