Individual
DR. JACK VICTOR CARLISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1601 GOLF COURSE RD, GRAND RAPIDS, MN 55744-8648
(218) 326-5000
(218) 326-1461
Mailing address
1601 GOLF COURSE RD, GRAND RAPIDS, MN 55744-8648
(218) 326-5000
(218) 326-1461
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31750
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
462700800
—
MN
Enumeration date
12/14/2005
Last updated
02/12/2013
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