Healthcare Provider Details

I. General information

NPI: 1194714469
Provider Name (Legal Business Name): JOSEPH J JARES III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 PARK DR
NEENAH WI
54956-2899
US

IV. Provider business mailing address

PO BOX 760
FOX ISLAND WA
98333-0760
US

V. Phone/Fax

Practice location:
  • Phone: 360-539-8487
  • Fax: 360-358-9944
Mailing address:
  • Phone: 360-539-8487
  • Fax: 603-589-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD60578578
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License NumberMD60578578
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number42460
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number42460
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: