Donald Ray Jack, M.D.

Primary specialty

Basic Emergency Medical TechnicianTaxonomy code 146N00000X

License

12521464546464 Issued in KY

Practice address

1644 Wilcox Ave
Hollywood, CA 90028-6206

Phone

(424) 202-0322

NPI assigned

Mar 15, 2010

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 15, 2010.

{
    "created_epoch": "1268611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268611200000",
    "number": "1497079875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 E. PROVIDENCIA AVE.",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "91205",
            "telephone_number": "424-202-0322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1644 WILCOX AVE",
            "city": "HOLLYWOOD",
            "state": "CA",
            "postal_code": "900286206",
            "telephone_number": "424-202-0322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "DONALD",
        "middle_name": "RAY",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-03-15",
        "last_updated": "2010-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "KY",
            "license": "12521464546464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katarena Lorraine Harris, LMFT
• Cecilia Saray Hill, IBCLC
• Hop Trung Nguyen, D.D.S.
• Nathan Horner
• Benjamin Island
• Ronnie Jerome Jackson
• Daria Jacob, RDN
• Jennifer Jara, D.C.
• Joel Frederick Fine, MD a Med
• James Kristoff Johansen

• All providers in Hollywood, CA
• Basic Emergency Medical Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2010; 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.