Healthcare Provider Details

I. General information

NPI: 1942463617
Provider Name (Legal Business Name): JEFFREY ALLEN ARCHINAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 HIGH ST STE A
WADSWORTH OH
44281-1869
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-336-3539
  • Fax: 330-334-4941
Mailing address:
  • Phone: 330-336-3539
  • Fax: 330-334-4941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.098237
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: