Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 980 | OK |
NPI | 1184782765 |
---|---|
Provider Name | Dr. Noel Jameson Jacobs |
First Address | Edmond, OK 73013-8954 |
Second Address | Oklahoma City, OK 73104-4600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 05/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200099360A | (05) | OK |