Individual
MR. JACKIE (JACK) DUWAYNE RURAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATP #64040
Contact information
Practice address
604 N NOLAN RIVER RD, CLEBURNE, TX 76033-7008
(817) 645-4718
(817) 641-2960
Mailing address
604 N NOLAN RIVER RD, CLEBURNE, TX 76033-7008
(817) 645-4718
(817) 641-2960
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015900601
—
TX
Enumeration date
02/03/2014
Last updated
02/03/2014
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