| Organization Name: | JAMES P. FRACKELTON, MD, INC |
| NPI Number: | 1366642498 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUSAN ANN WENGER (MANAGER) |
| Mailing Address: | 24700 Center Ridge Rd Westlake |
| State: | OH US |
| Postal Code: | 441455636 |
| Phone Number: | 4408350104 |
| Fax Number: | 4408352177 |
| NPI Enumeration Date: | 07/18/2007 |
| NPI Last Update Date: | 07/18/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |