Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | F4120 | TX |
NPI | 1124042411 |
---|---|
Provider Name | Jeffrey Jobe |
First Address | Austin, TX 78756-4010 |
Second Address | Austin, TX 78756-4010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89451S | BCBS PROV NO (01) | TX |
B23779 | (02) |