Brian W Jack M.D.

NPI 1053385120 - Family Medicine - 207Q00000X

NPI Details
NPI 1053385120
Gender Male
Enumeration Date 02/15/2006
Last Updated 06/30/2014
Entity Type Individual
Active Over 10 years ago
Practice Location
850 HARRISON AVE
YACC 4
BOSTON MA, 02118-4001, US
Phone (617) 414-2080
Fax (617) 414-2090
Business Location
720 HARRISON AVE
DOB 503
BOSTON MA, 02118-2371, US
Phone
Fax
Toxanomy
Taxonomy Code 207Q00000X
License State Massachusetts
License Number 154199
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According to our database, Brian W Jack M.D. NPI is 1053385120, taxonomy code is 207Q00000X and license number is 154199, license state is located at Massachusetts. Brian W Jack M.D. physically located at 850 Harrison Ave, Boston MA, 02118-4001. NPI Number Brian W Jack M.D. has the Individual type.

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1053385120 NPI number is provided on an as is basis without warranty of any kind. 1053385120 is maintained by the National Plan & Provider Enumeration System. The contents of Brian W Jack M.D. are for informational purposes only.