Provider Demographics
NPI:1215950506
Name:JACKSON, DANIEL AARON (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:AARON
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-1812
Mailing Address - Country:US
Mailing Address - Phone:234-312-2140
Mailing Address - Fax:234-312-2335
Practice Address - Street 1:1260 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-1812
Practice Address - Country:US
Practice Address - Phone:234-312-2140
Practice Address - Fax:234-312-2335
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.076879207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8437892OtherCIGNA
ME432127199Medicaid
ME100164OtherANTHEM
7902779OtherAETNA
P00302530OtherRAILROAD MEDICARE
ME432127199Medicaid