Individual
DR. JACOB BRUCE CANTRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
975 E. THIRD STREET, ATTN: PROVIDER ENROLLMENT, CHATTANOOGA, TN 37403
(423) 266-1490
(423) 778-2108
Mailing address
975 E. THIRD STREET, ATTN: PROVIDER ENROLLMENT, CHATTANOOGA, TN 37043
(423) 266-1490
(423) 778-2108
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
54013
TN
208M00000X
Hospitalist Physician
54013
TN
Other
Enumeration date
11/11/2009
Last updated
09/01/2016
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