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General NPI Number Information
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NPI Number | 1164431078
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Entity Type | Individual
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Provider Name | JACK H BRACKIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 1209 HIGHWAY 35 N SUITE A
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City | ROCKPORT
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State | TX
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Zip | 78382-3117
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Country | US
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Telephone | 361-729-9811
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Fax | 361-729-9819
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Provider Business Mailing Address
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Address Line | 1209 HIGHWAY 35 N SUITE A
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City | ROCKPORT
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State | TX
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Zip | 78382-3117
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Country | US
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Telephone | 361-729-9811
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Fax | 361-729-9819
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | J0446
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License Number State | TX
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