Individual
DR. JACK JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2800 MAIN ST, BRIDGEPORT, CT 06606-4201
(862) 812-7831
Mailing address
2800 MAIN ST, BRIDGEPORT, CT 06606-4201
(862) 812-7831
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
68885
CT
Other
Enumeration date
05/26/2015
Last updated
09/22/2021
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