Individual
JACOB THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
(765) 838-4698
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-128570
IL
208M00000X
Hospitalist Physician
01071565A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000781555
ANTHEM PROVIDER NUMBER FOR TIN 35-2030653
IN
05
—
036128570
—
IL
05
—
201083560
—
IN
Enumeration date
06/30/2008
Last updated
09/14/2023
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