Healthcare Provider Details

I. General information

NPI: 1477554079
Provider Name (Legal Business Name): TOMAS HUMBERTO JACOME JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD STE 102
BATON ROUGE LA
70808-4363
US

IV. Provider business mailing address

7777 HENNESSY BLVD STE 102
BATON ROUGE LA
70808-4363
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-2048
  • Fax: 225-765-1958
Mailing address:
  • Phone: 225-765-2048
  • Fax: 225-765-1958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number025420
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number025420
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: