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NPI Code Detail

MEDICARE: JACK ROBERT SCHLEIFFARTH M.D.

MEDICARE: JACK ROBERT SCHLEIFFARTH 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
1207Y00000XOtolaryngology Physician9104SD

General Provider Information

NPI Number : 1699972000
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK ROBERT SCHLEIFFARTH M.D.
Provider Business Mailing Address
First Line : 4940 5TH ST STE 2B
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-6026
Country : US
Telephone Number : 605-791-0602
Fax Number : 605-791-0978
Provider Business Practice Location Address
First Line : 4940 5TH ST STE 2B
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-6026
Country : US
Telephone Number : 605-791-0602
Fax Number : 605-791-0978
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2007
Last Update Date : 02/06/2019

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