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Individual

J. JACK CHAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
86 COLUMBUS RD, STE 203, ATHENS, OH 45701-1331
(740) 594-2624
(740) 594-7333
Mailing address
86 COLUMBUS RD, SUITE 203, ATHENS, OH 45701-1300
(740) 594-2624
(740) 594-7333

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
34005890
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0956881
OH
Enumeration date
05/23/2005
Last updated
05/19/2009
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