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General NPI Number Information
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NPI Number | 1124152236
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Entity Type | Organization
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Legal Business Name | JOB JACOB MD PLLC
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 08/01/2018
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Provider Practice Location Address
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Address Line | 965 CARSON CV STE A
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City | CONWAY
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State | AR
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Zip | 72034
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Country | US
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Telephone | 501-513-2628
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Fax | 501-513-2630
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Provider Business Mailing Address
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Address Line | PO BOX 10585
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City | CONWAY
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State | AR
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Zip | 72034-0009
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Country | US
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Telephone | 501-513-2628
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Fax | 501-513-2630
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOB JACOB
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Credential | M.D.,
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Telephone | 501-513-2628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MC-2479
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License Number State | AR
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