Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 02005164A | IN |
NPI | 1013377084 |
---|---|
Provider Name | Jacob Matthew Ernst |
First Address | Joint Base Lewis Mcchord, WA 98431-0001 |
Second Address | Joint Base Lewis Mcchord, WA 98431-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2016 |
Last Update Date | 09/07/2020 |