Laurie, Jack Alan

Laurie, Jack Alan is an individual health care provider with primary practice located at 6405 Day St , Riverside CA 92507-0901. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Laurie, Jack Alan can be contacted via phone (951) 697-5430.

Contact Information

Primary practice address
6405 Day St Riverside CA 92507-0901
Phone: (951) 697-5430
Fax: (951) 697-5488
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X G43352 California

Profile Details

NPI number 1063496545
LBN Legal business name Laurie, Jack Alan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 30th, 2005
Last updated Nov 15th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063496545 NPPES
Other ZZZ92058Z GROUP SITE LOCATION

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