Provider Demographics
NPI:1427535202
Name:AUDRY, JEDD JACK (MD)
Entity type:Individual
Prefix:DR
First Name:JEDD
Middle Name:JACK
Last Name:AUDRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4000 WELLNESS DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48670-1000
Mailing Address - Country:US
Mailing Address - Phone:844-832-1956
Mailing Address - Fax:989-633-5241
Practice Address - Street 1:1501 W CHISHOLM ST
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1401
Practice Address - Country:US
Practice Address - Phone:989-356-8060
Practice Address - Fax:989-356-7794
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301507428208VP0014X, 208VP0000X, 2084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine