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General NPI Number Information
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NPI Number | 1740302322
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Entity Type | Organization
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Legal Business Name | JACOBS FAMILY MEDICAL CLINIC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 102 E FOURTH ST
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City | DEQUINCY
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State | LA
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Zip | 70633-3502
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Country | US
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Telephone | 337-786-3030
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Fax | 337-786-5066
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Provider Business Mailing Address
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Address Line | 102 E FOURTH ST PO BOX 1018
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City | DEQUINCY
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State | LA
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Zip | 70633-3502
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Country | US
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Telephone | 337-786-3030
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Fax | 337-786-6066
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ERIC F JACOBS
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Credential | M.D.
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Telephone | 337-786-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 08646R
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License Number State | LA
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