Individual
JAKE THOMAS HOLLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4311 SUFFOLK ST, LAKE CHARLES, LA 70605-3936
(337) 477-9383
Mailing address
4311 SUFFOLK ST, LAKE CHARLES, LA 70605-3936
(337) 477-9383
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
013982
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1373150
—
LA
Enumeration date
06/04/2006
Last updated
08/18/2010
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