Doctor Name: | ROBERT LIONEL JACK |
NPI Number: | 1376601443 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | G17236 |
Business Practice Address: | 1225 Crane St Menlo Park, CA - 940254257 |
Business Phone Number: | 6503230231 |
Business Fax Number: | 6505658297 |
Mailing Address: | 2452 Watson Ct, PALO ALTO |
State: | CA |
Postal Code: | 943033216 |
Phone Number: | 6507216888 |
Fax Number: | 6505658297 |
NPI Enumeration Date: | 12/04/2006 |
NPI Last Update Date: | 01/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | G17236 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |