Individual
JARED BLAKE VINCENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
16845 TORTOISE ST, ROUND ROCK, TX 78664-8604
(512) 598-1411
Mailing address
PO BOX 2731, PFLUGERVILLE, TX 78691-2731
(512) 598-1411
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
09/01/2019
Last updated
12/10/2019
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