Provider Demographics
NPI:1114966603
Name:FRANCIS, JACK DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:DAVID
Last Name:FRANCIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7500 GREENWAY CENTER DR
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3502
Mailing Address - Country:US
Mailing Address - Phone:301-477-2000
Mailing Address - Fax:301-474-2389
Practice Address - Street 1:7500 GREENWAY CENTER DR
Practice Address - Street 2:8TH FLOOR
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3502
Practice Address - Country:US
Practice Address - Phone:301-477-2000
Practice Address - Fax:301-474-2389
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019191208800000X
DCMD9096208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
35301905OtherBCBS MD GREENBELT OFFICE
G02425M05OtherMEDICARE
57620006OtherBCBS DC
MD310891100Medicaid
6179215OtherCIGNA
432105237OtherBRAVO HEALTH
1467381OtherAETNA PPO
1901959OtherUNITED HEALTHCARE AMERICHOICE
35301906OtherBCBS MD BOWIE OFFICE
028039OtherJOHN HOPKINS
028039OtherPRIORITY PARTNERS
33112OtherOPTIMUM CHOICE
353019507OtherBCBS MD LAUREL OFFICE
4051788OtherAETNA PPO
P00439843OtherMEDICARE RAILROAD
1467381OtherAETNA PPO
G02425M05OtherMEDICARE