Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | E-2646 | AR |
NPI | 1053330175 |
---|---|
Provider Name | Dr. Jacob K Joseph |
First Address | Fort Smith, AR 72913-3528 |
Second Address | Fort Smith, AR 72903-4067 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 28/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053330175 | RR MEDICARE (01) | |
141426001 | (05) | AR |
G19106 | (02) |