Provider Demographics
NPI:1194714469
Name:JARES, JOSEPH J III (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:JARES
Suffix:III
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:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:FOX ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98333-0760
Mailing Address - Country:US
Mailing Address - Phone:360-539-8487
Mailing Address - Fax:603-589-9443
Practice Address - Street 1:318 PARK DR
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2899
Practice Address - Country:US
Practice Address - Phone:360-539-8487
Practice Address - Fax:360-358-9944
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD605785782084N0400X, 246ZE0600X
WI42460246ZE0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34005500Medicaid
WI000171147Medicare PIN
WI038671018Medicare PIN
E62230Medicare UPIN
MN130001416Medicare PIN
WI036945300Medicare PIN
WI000168402Medicare PIN