Fields, Jack Mark

Fields, Jack Mark is an individual health care provider with primary practice located at 3417 Ensign Rd Ne , Olympia WA 98506-5075. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Fields, Jack Mark can be contacted via phone (360) 493-4600.

Contact Information

Primary practice address
3417 Ensign Rd Ne Olympia WA 98506-5075
Phone: (360) 493-4600
Fax: (360) 493-4603
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X MD00045508 Washington

Profile Details

NPI number 1326016379
LBN Legal business name Fields, Jack Mark
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 8th, 2006
Last updated Jan 24th, 2019 - about 5 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 1326016379 NPPES
Washington Other 0384204 LNI-RADIA
Washington MEDICAID 8450157 LNI-RADIA
Washington Other 0207711 LNI-RADIA
Washington MEDICAID 1043717 LNI-RADIA

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