Doctor Name: | DR. JACK R. INYART |
NPI Number: | 1629230651 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 15120 |
Business Practice Address: | 610 E Longview Dr Ste A Appleton, WI - 549112165 |
Business Phone Number: | 9202461555 |
Business Fax Number: | 9207439982 |
Mailing Address: | 947 S 20th Pl, STURGEON BAY |
State: | WI |
Postal Code: | 542351013 |
Phone Number: | 9202461555 |
Fax Number: | 9207439982 |
NPI Enumeration Date: | 07/01/2008 |
NPI Last Update Date: | 01/18/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 15120 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |