Provider Demographics
NPI:1659353878
Name:JACKS, WILLIAM P (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:JACKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2031 MCDANIEL ST STE 250
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-6309
Mailing Address - Country:US
Mailing Address - Phone:702-649-9070
Mailing Address - Fax:702-649-9080
Practice Address - Street 1:2031 MCDANIEL ST STE 250
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6309
Practice Address - Country:US
Practice Address - Phone:702-649-9070
Practice Address - Fax:702-649-9080
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2015-03-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV9468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV38523Medicare PIN