Healthcare Provider Details

I. General information

NPI: 1124134374
Provider Name (Legal Business Name): TINA MARIE JOBE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ALCORN DR STE 1E
CORINTH MS
38834-9071
US

IV. Provider business mailing address

PO BOX 24023 DEPT 03-019
JACKSON MS
39225-4023
US

V. Phone/Fax

Practice location:
  • Phone: 662-665-0457
  • Fax: 662-665-0458
Mailing address:
  • Phone: 662-665-0457
  • Fax: 662-665-0458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number19157
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: