Dial, Jack

Dial, Jack is an individual health care provider with primary practice located at 204 E 19Th St , Panama City FL 32405-4707. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Dial, Jack can be contacted via phone (850) 784-2105.

Contact Information

Primary practice address
204 E 19Th St Panama City FL 32405-4707
Phone: (850) 784-2105
Fax: (850) 522-9453
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X

Profile Details

NPI number 1467519116
LBN Legal business name Dial, Jack
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 2nd, 2007
Last updated Jul 8th, 2007 - about 17 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1467519116 NPPES
Florida Other FLPA0001804 PA LIC NUMBER

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