Individual
MR. JACOB LOUIS SLANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
408 COLLEGE AVE, CLEMSON, SC 29631-1441
(864) 650-0804
Mailing address
408 COLLEGE AVE, CLEMSON, SC 29631-1441
(864) 650-0804
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
303469
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZCX833239112903
BLUE CROSS BLUE SHIELD
—
Enumeration date
07/24/2020
Last updated
07/24/2020
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