Individual
DR. JACK ALLAN PAINTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
26 BROAD ST, MARTINSVILLE, VA 24112-2802
(276) 632-4200
Mailing address
26 BROAD ST, MARTINSVILLE, VA 24112-2802
(276) 632-4200
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
0101042801
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11053313
CAQH
—
01
—
1841452018
HEART OF VIRGINIA PC
VA
Enumeration date
12/08/2006
Last updated
07/14/2008
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