Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 0103442138 | VA |
NPI | 1003442138 |
---|---|
Provider Name | Zach Jarrett |
First Address | Jbsa Fort Sam Houston, TN 78234-4504 |
Second Address | Jbsa Fort Sam Houston, TN 78234-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2020 |
Last Update Date | 25/01/2022 |