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Individual
JACK H AVERY
Active
Individual
JACK H AVERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RT (R) (MRI)(QM)(CT)
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
1019
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0760123
—
MT
Enumeration date
10/24/2006
Last updated
11/16/2007
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