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General NPI Number Information
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NPI Number | 1720020431
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Entity Type | Individual
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Provider Name | JACOB SAJ OOMMEN M.D
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Gender | Male
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 19204 N 93RD WAY
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-5528
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Country | US
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Telephone | 480-821-9339
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Fax | 480-821-9555
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Provider Business Mailing Address
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Address Line | 19204 N 93RD WAY
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-5528
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Country | US
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Telephone | 480-280-7007
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Fax | 480-821-9555
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 04-25365
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 112403
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 036-087704
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 37316
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License Number State | AZ
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