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General NPI Number Information
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NPI Number | 1427535202
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Entity Type | Individual
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Provider Name | JEDD JACK AUDRY MD
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Gender | Male
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Dates
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Enumeration Date | 07/24/2018
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 1501 W CHISHOLM ST
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City | ALPENA
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State | MI
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Zip | 49707-1401
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Country | US
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Telephone | 989-356-8060
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Fax | 989-356-7794
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Provider Business Mailing Address
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Address Line | 4000 WELLNESS DR
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City | MIDLAND
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State | MI
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Zip | 48670-1000
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Country | US
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Telephone | 844-832-1956
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Fax | 989-633-5241
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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 | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 4301507428
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 4301507428
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301507428
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License Number State | MI
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