MEDICARE: WILLIAM P JACKS MD CHARTERED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1306879911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM P JACKS MD CHARTERED

Provider Business Mailing Address
First Line	:	2031 MCDANIEL ST STE 250
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030-6309
Country	:	US
Telephone Number	:	702-649-9070
Fax Number	:	702-649-9080

Provider Business Practice Location Address
First Line	:	2031 MCDANIEL ST STE 250
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030-6309
Country	:	US
Telephone Number	:	702-649-9070
Fax Number	:	702-649-9080

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM P JACKS
Credential	:	MD
Telephone Number	:	702-649-9070

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	03/02/2018

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