Individual
JACK KACZMAREK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
36 SW NYE ST, NEWPORT, OR 97365-3821
(541) 265-4179
Mailing address
111 FRED TAYLOR RD, SILETZ, OR 97380-9708
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
9734
OR
Other
Enumeration date
02/17/2006
Last updated
07/08/2010
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