Individual
SODARAN P JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 W MAPLE ST, FARMINGTON, NM 87401-5630
(505) 609-6463
(505) 609-6474
Mailing address
PO BOX 6210, FARMINGTON, NM 87499-6210
(505) 609-2258
(505) 609-2259
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD2006-0732
NM
208M00000X
Hospitalist Physician
Primary
MD2006-0732
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
93733577
—
NM
Enumeration date
07/13/2006
Last updated
07/31/2017
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