Jack Ronald Tacker, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

MD00028053 Issued in WA

Practice address

19160 Front St NE
Poulsbo, WA 98370

Phone

(360) 779-7500

Fax

(360) 626-0600

NPI assigned

Jul 22, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Martha and Mary Lutheran Services

  • Geriatric Medicine (Internal Medicine) Physician
  • Poulsbo, WA
  • NPI 1285977983
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1248220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370390400000",
    "number": "1336379403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 127",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983700127",
            "telephone_number": "360-779-7500",
            "fax_number": "253-288-2203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19160 FRONT ST NE",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "98370",
            "telephone_number": "360-779-7500",
            "fax_number": "360-626-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKER",
        "first_name": "JACK",
        "middle_name": "RONALD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-22",
        "last_updated": "2013-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WA",
            "license": "MD00028053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Svetlana Swan, ARNP
• Erik William Swanson, LMP
• Virginia E Swanson, MD
• Linda Diane Swartz, M.D.
• Angela Nichole Szatkowski, D.O.
• Shannon June Tallon, MA
• Richard H. Tangen, DDS
• Grant Edward Taylor, D.C.
• Mark Richard Taylor, ANRP, FNP
• Michael Testa, CNOR, RNFA

• General Practice Physician in Poulsbo, WA
• Providers in Poulsbo, WA by specialty
• General Practice Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.