Individual
LUSTER I. JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6161 S YALE AVE, ER DEPT, TULSA, OK 74136-1902
(918) 494-6528
(405) 749-4561
Mailing address
PO BOX 22063, DEPT 0491, TULSA, OK 74121-2063
(405) 751-4664
(405) 749-4561
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
12716
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100108940C
—
OK
Enumeration date
04/27/2006
Last updated
05/27/2008
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