Individual
SERA L JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
802 GREEN VALLEY RD, SUITE 106, GREENSBORO, NC 27408-7041
(336) 716-2255
(336) 716-9440
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-9440
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
9600264
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1197J
BCBS
NC
05
—
891197J
—
NC
Enumeration date
05/23/2006
Last updated
11/18/2011
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