MEDICARE: DR. TOMAS HUMBERTO JACOME JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0102X	Surgical Critical Care Physician	025420	LA
2	208600000X	Surgery Physician	025420	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	363070	OTHER	WELLCARE

General Provider Information

NPI Number	:	1477554079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOMAS HUMBERTO JACOME JR. MD

Provider Business Mailing Address
First Line	:	7777 HENNESSY BLVD STE 102
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4363
Country	:	US
Telephone Number	:	225-765-2048
Fax Number	:	225-765-1958

Provider Business Practice Location Address
First Line	:	7777 HENNESSY BLVD STE 102
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4363
Country	:	US
Telephone Number	:	225-765-2048
Fax Number	:	225-765-1958

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	03/26/2021

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Directions to “ DR. TOMAS HUMBERTO JACOME JR. MD” Practice Location

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