Robert Lionel Jack, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

G17236 Issued in CA

Practice address

1225 Crane St
Menlo Park, CA 94025-4257

Phone

(650) 323-0231

Fax

(650) 565-8297

NPI assigned

Dec 4, 2006

Sex

Male

Sole proprietor

No

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

State licenses

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325548800000",
    "number": "1376601443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2452 WATSON CT",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943033216",
            "telephone_number": "650-721-6888",
            "fax_number": "650-565-8297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 CRANE ST",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940254257",
            "telephone_number": "650-323-0231",
            "fax_number": "650-565-8297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "ROBERT",
        "middle_name": "LIONEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-04",
        "last_updated": "2012-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G17236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Inadvance Medicine Associates West, P. C.
• Therese Inkmann, MA, LMFT
• Megan Irvin, LMFT
• Vince Iwuji, RN
• Homeira Izadi, MD
• Alison Moon Jackson, PSY.D.
• Jacqueline D.S. Jackson, PH.D.
• Lisa Jacobs, M.D.
• Matthew Townsend Jacobs
• Michael B. Jacobs, M.D.

• Specialist in Menlo Park, CA
• Providers in Menlo Park, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2012; 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.