Jack, Brian W

Jack, Brian W is an individual health care provider with primary practice located at 850 Harrison Ave Yacc 4, Boston MA 02118-4001. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Jack, Brian W can be contacted via phone (617) 414-2080.

Contact Information

Primary practice address
850 Harrison Ave Yacc 4 Boston MA 02118-4001
Phone: (617) 414-2080
Fax: (617) 414-2090
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 154199 Massachusetts

Profile Details

NPI number 1053385120
LBN Legal business name Jack, Brian W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 15th, 2006
Last updated Jun 30th, 2014 - about 10 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 1053385120 NPPES
Massachusetts MEDICAID 110059621A

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