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NPI Code Detail

MEDICARE: JACOB PELTIER

MEDICARE: JACOB PELTIER
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
1171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2RAC-5050OTHERLALAADRA

General Provider Information

NPI Number : 1578033163
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB PELTIER
Provider Business Mailing Address
First Line : 150 CORA DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70815-4201
Country : US
Telephone Number : 225-387-1611
Fax Number :
Provider Business Practice Location Address
First Line : 150 CORA DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70815-4201
Country : US
Telephone Number : 225-387-1611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2018
Last Update Date : 05/06/2021

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