Jaicks, Russell Raymond
Jaicks, Russell Raymond is an individual health care provider with primary practice located at 720 W Oak St Suite 101, Kissimmee FL 34741-4989. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Jaicks, Russell Raymond can be contacted via phone (407) 846-3166.Contact Information
Primary practice address
720 W Oak St Suite 101
Kissimmee FL 34741-4989
Phone: (407) 846-3166
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | ME113621 | Florida |
Profile Details
| NPI number | 1184727414 |
|---|---|
| LBN Legal business name | Jaicks, Russell Raymond |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 5th, 2006 |
| Last updated | Apr 18th, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184727414 | NPPES |
| Colorado | MEDICAID | 28788834 |
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