Provider Demographics
NPI:1518149228
Name:MCBRIDE, JACK MARVIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:MARVIN
Last Name:MCBRIDE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:5025A OLD CLINIC
Mailing Address - Street 2:CAMPUS BOX 7550
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7550
Mailing Address - Country:US
Mailing Address - Phone:919-843-4096
Mailing Address - Fax:919-962-9795
Practice Address - Street 1:5025A OLD CLINIC
Practice Address - Street 2:CAMPUS BOX 7550
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7550
Practice Address - Country:US
Practice Address - Phone:919-843-4096
Practice Address - Fax:919-962-9795
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2021-03-31
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Provider Licenses
StateLicense IDTaxonomies
NC30068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8955609Medicaid
NCC89246Medicare PIN