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General NPI Number Information
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NPI Number | 1770886392
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Entity Type | Organization
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Legal Business Name | VIGILANT PARTNERS, S.C.
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Dates
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Enumeration Date | 12/21/2010
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Last Update Date | 12/21/2010
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Provider Practice Location Address
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Address Line | 318 PARK DR
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City | NEENAH
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State | WI
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Zip | 54956-2899
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Country | US
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Telephone | 920-284-5243
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Fax |
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Provider Business Mailing Address
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Address Line | 318 PARK DR
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City | NEENAH
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State | WI
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Zip | 54956-2899
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Country | US
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Telephone | 920-284-5243
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH J JARES III
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Credential | MD
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Telephone | 920-284-5243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | 42460020
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License Number State | WI
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