Individual
JACOB DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
606 COLONIAL DR STE B, BATON ROUGE, LA 70806-6535
(225) 406-7670
Mailing address
606 COLONIAL DR STE B, BATON ROUGE, LA 70806-6535
(225) 406-7670
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
5559
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
601008607
—
LA
Enumeration date
01/02/2019
Last updated
01/02/2019
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