Individual
TODDY JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CEO
Contact information
Practice address
801 ROAD TO SIXFLAGS STREET, 144, ARLINGTON, TX 76012
(817) 461-0034
(817) 461-0035
Mailing address
801 ROAD TO SIXFLAGS STREET, 144, ARLINGTON, TX 76012
(817) 461-0034
(817) 461-0035
Taxonomy
Speciality
Code
Description
License number
State
163WX0200X
Oncology Registered Nurse
4765290876
TX
171W00000X
Contractor
Primary
345782195
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6787445908
MULTIPLE LICENCE
TX
Enumeration date
01/03/2011
Last updated
01/03/2011
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