Job Jacob MD PLLC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

MC-2479 Issued in AR

Legal business name

JOB JACOB MD PLLC

Practice address

965 Carson CV Ste a
Conway, AR 72034

Phone

(501) 513-2628

Fax

(501) 513-2630

NPI assigned

Mar 14, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Job Jacob, M.D.,

Title

Owner

Phone

(501) 513-2628

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533081600000",
    "number": "1124152236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10585",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720340009",
            "telephone_number": "501-513-2628",
            "fax_number": "501-513-2630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 CARSON CV STE A",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "72034",
            "telephone_number": "501-513-2628",
            "fax_number": "501-513-2630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOB JACOB MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2018-08-01",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "JOB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-513-2628",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D.,"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AR",
            "license": "MC-2479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "161356002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE PLLC NUMBER",
            "identifier": "MC-2479",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Myles Jerrels
• Brayden Michael Jimerson
• JJJ Smith, Inc
• JM Wellness, LLC
• JMS Consulting, LLC
• John Nicholas Clark D.D.S., PA
• Jaden Johns
• Jenaijah Johns, RECOVERY ASSISTANT
• Crissa Diane Johnson Breytenbach, SLP
• Robyn Johnson-Breytenbach

• All providers in Conway, AR
• Gastroenterology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.