Organization
LORAN C JACOBS JR PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORAN C. JACOBS JR. CRNA (SOLE MEMBER)
(602) 273-6770
Entity
Organization
Contact information
Practice address
807 S PONDEROSA ST, PAYSON, AZ 85541-5542
(602) 273-6770
(602) 889-0489
Mailing address
PO BOX 29211, PHOENIX, AZ 85038-9211
(602) 273-6770
(602) 889-0489
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN151239
AZ
Other
Enumeration date
04/04/2008
Last updated
04/04/2008
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