Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | L2343 | TX |
NPI | 1093714966 |
---|---|
Provider Name | Aris Nicholas Jacob |
First Address | Cape Coral, FL 33909-5251 |
Second Address | Cape Coral, FL 33909-5422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 29/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8AW333 | BCBS (01) | TX |
I26269 | (02) | TX |
P00246340 | RR MEDICARE (01) | TX |