Provider Demographics
NPI:1558324186
Name:ENGLERT, JACK MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:MANUEL
Last Name:ENGLERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 BOB WALLACE AVE SW
Mailing Address - Street 2:SUITE D
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3847
Mailing Address - Country:US
Mailing Address - Phone:256-517-1507
Mailing Address - Fax:256-517-1508
Practice Address - Street 1:101 BOB WALLACE AVE SW
Practice Address - Street 2:SUITE D
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3847
Practice Address - Country:US
Practice Address - Phone:256-517-1507
Practice Address - Fax:256-517-1508
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2010-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00015840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E87616Medicare UPIN
AL051503250Medicare ID - Type Unspecified