Individual
JACK ROUTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
6325 MAIN ST STE 200, WILLIAMSVILLE, NY 14221-5617
(716) 630-1295
(716) 250-5999
Mailing address
425 ESSJAY RD STE 170, WILLIAMSVILLE, NY 14221-8235
(716) 630-1219
(716) 817-1769
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
007175
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/25/2016
Last updated
09/27/2023
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