Individual
REGINALD JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10001 LITTLE TREE LN, FORT WORTH, TX 76179-2698
(504) 355-7089
Mailing address
10001 LITTLE TREE LN, FORT WORTH, TX 76179-2698
(504) 355-7089
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
01/14/2025
Last updated
01/24/2025
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