Basic Information
| Provider Information | |||||||||
| NPI: | 1093934341 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JACK | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HOAR | ||||||||
| OtherFirstName: | MEGAN | ||||||||
| OtherMiddleName: | C | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4601 N FEDERAL HWY | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334315133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613628000 | ||||||||
| FaxNumber: | 5614476806 | ||||||||
| Practice Location | |||||||||
| Address1: | 4601 N FEDERAL HWY | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334315133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613628000 | ||||||||
| FaxNumber: | 5614476806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 02/07/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | ME107194 | FL | N | Allopathic & Osteopathic Physicians | Dermatology | 208200000X | ME107194 | FL | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.