Individual
JACK DANIEL IP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2811 TIETON DR, YAKIMA, WA 98902-3761
(509) 575-8000
Mailing address
2811 TIETON DR, YAKIMA, WA 98902-3761
(509) 575-8000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
20086
NV
207R00000X
Internal Medicine Physician
Primary
MD61042100
WA
208M00000X
Hospitalist Physician
20086
NV
Other
Enumeration date
04/03/2017
Last updated
01/23/2023
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