Healthcare Provider Details

I. General information

NPI: 1063661718
Provider Name (Legal Business Name): R. DANIEL JACOB, M.D.,A.P.M.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 HOUMA BLVD SUITE 340
METAIRIE LA
70006-3000
US

IV. Provider business mailing address

351 VINCENT AVE
METAIRIE LA
70005-4419
US

V. Phone/Fax

Practice location:
  • Phone: 504-454-3611
  • Fax: 504-888-9452
Mailing address:
  • Phone: 504-454-3611
  • Fax: 504-888-9452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberMD.012606
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License NumberMD.012606
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberMD.012606
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberMD.012606
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberMD.012606
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberMD.012606
License Number StateLA
# 7
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberMD.012606
License Number StateLA
# 8
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD.012606
License Number StateLA

VIII. Authorized Official

Name: RUDOLPH DANIEL JACOB
Title or Position: PRESIDENT
Credential: M.D.
Phone: 504-454-3611