MEDICARE: DR. JACK MANUEL ENGLERT M.D.

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	00015840	AL

General Provider Information

NPI Number	:	1558324186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK MANUEL ENGLERT M.D.

Provider Business Mailing Address
First Line	:	101 BOB WALLACE AVE SW
Second Line	:	SUITE D
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-3847
Country	:	US
Telephone Number	:	256-517-1507
Fax Number	:	256-517-1508

Provider Business Practice Location Address
First Line	:	101 BOB WALLACE AVE SW
Second Line	:	SUITE D
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-3847
Country	:	US
Telephone Number	:	256-517-1507
Fax Number	:	256-517-1508

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	01/23/2010

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