Individual
MR. JACK DAVID CAPPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2026 S JACKSON ST, JACKSONVILLE, TX 75766-5822
(903) 541-4500
Mailing address
PO BOX 847522, DALLAS, TX 75284-7522
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
236590
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3033002
—
TX
01
—
88838U
BCBS
TX
Enumeration date
07/26/2006
Last updated
10/10/2014
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