Provider Demographics
NPI:1851308662
Name:PACKARD, JOHN M JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:PACKARD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:45 MEDICAL PARK DR.
Mailing Address - Street 2:SUITE B
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976
Mailing Address - Country:US
Mailing Address - Phone:256-571-8969
Mailing Address - Fax:256-571-8980
Practice Address - Street 1:45 MEDICAL PARK DR.
Practice Address - Street 2:SUITE B
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976
Practice Address - Country:US
Practice Address - Phone:256-571-8969
Practice Address - Fax:256-571-8980
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL6719174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC76801Medicare UPIN