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Organization

JLR FAMILY PRACTICE, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JENNIFER LYNN RICHARDSON (PRESIDENT)
(812) 634-7726
Entity
Organization

Contact information

Practice address
3404 NEWTON ST, JASPER, IN 47546-1020
(812) 634-7726
Mailing address
3404 NEWTON ST, JASPER, IN 47546-1020

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01047337A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200227510B
IN
Enumeration date
07/05/2007
Last updated
04/19/2008
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