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General NPI Number Information
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NPI Number | 1003246828
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Entity Type | Organization
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Legal Business Name | JACOB GENERAL SURGERY, LLC
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Dates
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Enumeration Date | 11/14/2013
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 4228 HOUMA BLVD SUITE 220
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City | METAIRIE
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State | LA
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Zip | 70006-3000
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Country | US
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Telephone | 504-264-9353
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Fax | 504-301-9312
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Provider Business Mailing Address
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Address Line | 4228 HOUMA BLVD SUITE 220
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City | METAIRIE
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State | LA
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Zip | 70006-3000
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Country | US
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Telephone | 504-264-9353
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Fax | 504-301-9312
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Authorized Official
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Title or Position | OWNER
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Name | DR. RYAN ANDRE JACOB
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Credential | MD
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Telephone | 504-264-9353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 201551
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License Number State | LA
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