Individual
JOE M PACK
Active
Individual
JOE M PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0102201406
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006409806
—
VA
01
—
200026
LUNG
—
01
—
213824
CARELINK
—
05
—
3003781000
—
WV
01
—
465498
ANTHEM
VA
01
—
465499
ANTHEM
WV
01
—
541839718
C&O
—
01
—
54183971800
WV WORKERS COMPENSATION
WV
01
—
541839718103
BS MOUNTAIN STATE
WV
01
—
541839718104
BS MOUNTAIN STATE
VA
01
—
5431529
CCN
—
01
—
7194496
AETNA
—
Enumeration date
06/16/2005
Last updated
10/15/2011
Update your record
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