Individual
JACKYLIN CAPARAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3909 NEW VISION DR, FORT WAYNE, IN 46845
(260) 469-6602
(260) 969-3065
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01070707A
IN
208M00000X
Hospitalist Physician
01070707A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201057340
—
IN
01
—
ANTHEM
000000762410
IN
01
—
P01074066
R.R. MEDICARE
IN
Enumeration date
02/26/2011
Last updated
10/20/2022
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