Individual
JASON M ZACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4430 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-9098
(573) 596-1769
(573) 596-1783
Mailing address
4430 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-9098
(573) 596-1769
(573) 596-1783
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0101259277
VA
207N00000X
Dermatology Physician
MD53344
IA
Other
Enumeration date
06/13/2014
Last updated
01/30/2025
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