Healthcare Provider Details

I. General information

NPI: 1063772556
Provider Name (Legal Business Name): JACOB MICHAEL HEBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 THOMAS RD STE 201
WEST MONROE LA
71291-7365
US

IV. Provider business mailing address

102 THOMAS RD. SUITE 201
WEST MONROE LA
71291-2429
US

V. Phone/Fax

Practice location:
  • Phone: 318-329-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.207320
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: