| Doctor Name: | DR. JACK RONALD TACKER |
| NPI Number: | 1336379403 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | MD00028053 |
| Business Practice Address: | 19160 Front St Ne Poulsbo, WA - 98370 |
| Business Phone Number: | 3607797500 |
| Business Fax Number: | 3606260600 |
| Mailing Address: | Po Box 127, POULSBO |
| State: | WA |
| Postal Code: | 983700127 |
| Phone Number: | 3607797500 |
| Fax Number: | 2532882203 |
| NPI Enumeration Date: | 07/22/2009 |
| NPI Last Update Date: | 06/05/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MD00028053 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |