Individual
MR. DONALD RAY JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1644 WILCOX AVE, HOLLYWOOD, CA 90028-6206
(424) 202-0322
Mailing address
180 E. PROVIDENCIA AVE., BURBANK, CA 91205
(424) 202-0322
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
12521464546464
KY
Other
Enumeration date
03/15/2010
Last updated
03/15/2010
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