Healthcare Provider Details

I. General information

NPI: 1396743365
Provider Name (Legal Business Name): JEFFERY PAUL COURSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W EXCHANGE ST #225
AKRON OH
44302-1704
US

IV. Provider business mailing address

224 W EXCHANGE ST #225
AKRON OH
44302-1704
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-4377
  • Fax: 330-761-2492
Mailing address:
  • Phone: 330-344-4377
  • Fax: 330-761-2492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number34006842
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number34006842
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: