Individual
ALEXANDER ROBERT JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 CORPORATE DR STE 240, LADERA RANCH, CA 92694-2111
(949) 364-8411
Mailing address
PO BOX 5127, EVERETT, WA 98206-5127
(425) 258-3900
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
C179601
CA
Other
Enumeration date
04/01/2009
Last updated
12/22/2022
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