Individual
DR. BOBBY MATHEW JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4420 LAKE BOONE TRL, RALEIGH, NC 27607-7505
(919) 784-5050
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
01085787A
IN
207RG0100X
Gastroenterology Physician
Primary
2023-00513
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/26/2014
Last updated
07/31/2023
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