Individual
DR. JACK JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3525 PRYTANIA STREET, SUITE 206, NEW ORLEANS, LA 70115
(504) 897-8281
(504) 897-5604
Mailing address
3600 PRYTANIA ST, SUITE 35, NEW ORLEANS, LA 70115-3628
(504) 897-7197
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
011071
LA
207VG0400X
Gynecology Physician
Primary
011071
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1133191
—
LA
05
—
1943479
—
LA
Enumeration date
01/16/2007
Last updated
03/06/2019
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