Healthcare Provider Details

I. General information

NPI: 1467499004
Provider Name (Legal Business Name): JAMIE LEE ZUCKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 TUSCARAWAS ST W SUITE 200
CANTON OH
44708-4644
US

IV. Provider business mailing address

2600 TUSCARAWAS ST W SUITE 200
CANTON OH
44708-4644
US

V. Phone/Fax

Practice location:
  • Phone: 330-456-0047
  • Fax: 330-456-9308
Mailing address:
  • Phone: 330-456-0047
  • Fax: 330-456-9308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35051055Z
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: