Individual
ANTONY THEKKUMPURAM JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
30 E APPLE ST, STE L200, DAYTON, OH 45409-2932
(937) 208-2020
(937) 208-2109
Mailing address
30 E APPLE ST, STE L200, DAYTON, OH 45409-2932
(937) 208-2020
(937) 208-2109
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
35.058320
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0739366
—
OH
Enumeration date
06/17/2005
Last updated
08/18/2014
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