Individual
DR. JONATHAN EBERHARD MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
185 QUEEN CITY AVE, ELLIOT ORTHOPAEDIC SURGERY SPECIALISTS, MANCHESTER, NH 03101-7100
(603) 625-1655
(603) 626-4686
Mailing address
185 QUEEN CITY AVE, ELLIOT ORTHOPAEDIC SURGERY SPECIALISTS, MANCHESTER, NH 03101-7100
(603) 625-1655
(603) 626-4686
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
33787
AZ
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
50942
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34952800
—
WI
Enumeration date
10/18/2005
Last updated
04/13/2011
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