Provider Demographics
NPI:1770782369
Name:NEEDHAM, JACK NEWTON JR (MD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:NEWTON
Last Name:NEEDHAM
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-1198
Mailing Address - Country:US
Mailing Address - Phone:325-670-4220
Mailing Address - Fax:325-672-8292
Practice Address - Street 1:1924 PINE ST
Practice Address - Street 2:SUITE 501
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2451
Practice Address - Country:US
Practice Address - Phone:325-670-4333
Practice Address - Fax:325-670-4336
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2013-04-09
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08762800208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery