MEDICARE: JACK M ENGLERT MD PC

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	AL15840	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	051503250	OTHER	AL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E87616	OTHER	AL	UPIN

General Provider Information

NPI Number	:	1942531959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACK M ENGLERT MD PC

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	:	PRESIDENT
Name	:	DR. JACK MANUEL ENGLERT
Credential	:	MD
Telephone Number	:	256-517-1507

Provider Enumeration Date	:	01/15/2010
Last Update Date	:	01/23/2010

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Directions to “JACK M ENGLERT MD PC ” Practice Location

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