MEDICARE: WILLIAM P JACKS MD

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	9468	NV

General Provider Information

NPI Number	:	1659353878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM P JACKS MD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	03/12/2015

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Directions to “ WILLIAM P JACKS MD” Practice Location

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