Provider Demographics
NPI:1023437720
Name:JACK, ANNA (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:JACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 E RIDGE RD STE 800
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-1936
Mailing Address - Country:US
Mailing Address - Phone:585-341-3600
Mailing Address - Fax:585-266-3169
Practice Address - Street 1:999 E RIDGE RD STE 800
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621
Practice Address - Country:US
Practice Address - Phone:585-341-3600
Practice Address - Fax:585-266-3169
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine