Individual
DR. JASON M JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2000 STONEGATE TRL, SUITE 100, BIRMINGHAM, AL 35242-2246
(205) 298-8660
(205) 298-8664
Mailing address
2000 STONEGATE TRL, SUITE 100, BIRMINGHAM, AL 35242-2246
(205) 298-8660
(205) 298-8664
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
00026747
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51040131
BCBS OF AL
AL
01
—
51591941
BCBS OF AL
AL
01
—
51591942
BCBS OF AL
AL
01
—
51591946
BCBS OF AL
AL
Enumeration date
05/18/2006
Last updated
10/20/2011
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