Individual
JACK RICHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
33 STANIFORD ST, PROVIDENCE, RI 02905-3105
(401) 421-8800
(401) 421-2492
Mailing address
36 WHETSTONE ST, WEST NEWBURY, MA 01985-1432
(978) 914-4086
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01719
RI
Other
Enumeration date
07/15/2024
Last updated
10/28/2024
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