Individual
DR. JACK VINING
Active
Individual
DR. JACK VINING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD12819
OR
207R00000X
Internal Medicine Physician
MD12819
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0190386
WA L & I
—
05
—
261156
—
OR
05
—
8378382
—
WA
01
—
97128A002
CHAMPUS
—
01
—
D86802
PROVIDENCE
—
01
—
JM9451
PACC
—
01
—
P00333023
RAILROAD MEDICARE
—
05
—
XPY185640
—
CA
Enumeration date
06/14/2006
Last updated
11/28/2007
Update your record
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