Healthcare Provider Details

I. General information

NPI: 1912649070
Provider Name (Legal Business Name): JACOB COEUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MADISON AVE STE 447
MEMPHIS TN
38103-3438
US

IV. Provider business mailing address

920 MADISON AVE STE 447
MEMPHIS TN
38103-3438
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-5814
  • Fax:
Mailing address:
  • Phone: 901-448-5814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number74335
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0077858
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0077858
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number74335
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: