Individual
PREMA M JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3850 GRANT AVE, SUITE 100, LOVELAND, CO 80538-8431
(970) 776-1862
(970) 482-9646
Mailing address
4674 SNOW MESA DRIVE, SUITE 140, FORT COLLINS, CO 80528
(970) 225-5010
(970) 482-9646
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
25MA04062800
NJ
207Q00000X
Family Medicine Physician
Primary
43958
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18905072
—
CO
Enumeration date
01/16/2006
Last updated
11/25/2015
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