Individual
DR. JACK RONALD TACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19160 FRONT ST NE, POULSBO, WA 98370
(360) 779-7500
(360) 626-0600
Mailing address
PO BOX 127, POULSBO, WA 98370-0127
(360) 779-7500
(253) 288-2203
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
MD00028053
WA
Other
Enumeration date
07/22/2009
Last updated
06/05/2013
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