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Individual
DR. JACK LAWRENCE MAYER
Active
Individual
DR. JACK LAWRENCE MAYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., FAAP
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
042-0004728
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0004626
—
VT
01
—
26P885
MVP ID#
—
01
—
4626
BCVT
VT
Enumeration date
04/26/2006
Last updated
07/13/2026
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