Eberhart, Jack Henry

Eberhart, Jack Henry is an individual health care provider with primary practice located at 2300 E 30Th St Bldg D-102, Farmington NM 87401-8990. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Plastic Surgery within the Head & Neck, Allopathic & Osteopathic Physicians / Otolaryngic Allergy. Allopathic & Osteopathic Physicians / Plastic Surgery within the Head & Neck is his primary health care specialty. Eberhart, Jack Henry can be contacted via phone (505) 327-4429.

Contact Information

Primary practice address
2300 E 30Th St Bldg D-102 Farmington NM 87401-8990
Phone: (505) 327-4429
Fax: (505) 327-4420
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic Surgery within the Head & Neck 207YX0007X 97-223 New Mexico
Allopathic & Osteopathic Physicians / Otolaryngic Allergy 207YX0602X 97-223 New Mexico

Profile Details

NPI number 1215969860
LBN Legal business name Eberhart, Jack Henry
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 6th, 2006
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 1215969860 NPPES
New Mexico MEDICAID R7435

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