Organization
JOB JACOB MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOB JACOB M.D., (OWNER)
(501) 513-2628
Entity
Organization
Contact information
Practice address
965 CARSON CV STE A, CONWAY, AR 72034
(501) 513-2628
(501) 513-2630
Mailing address
PO BOX 10585, CONWAY, AR 72034-0009
(501) 513-2628
(501) 513-2630
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MC-2479
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161356002
—
AR
01
—
MC-2479
STATE LICENSE PLLC NUMBER
AR
Enumeration date
03/14/2007
Last updated
08/01/2018
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