Provider Demographics
NPI:1659395382
Name:CAREY, JACK P (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:P
Last Name:CAREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26116 FAWNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-8690
Mailing Address - Country:US
Mailing Address - Phone:239-948-9881
Mailing Address - Fax:
Practice Address - Street 1:26116 FAWNWOOD CT
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-8690
Practice Address - Country:US
Practice Address - Phone:239-948-9881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD19342207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery