Provider Demographics
NPI:1104845163
Name:JOBE, DARRELL I (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:I
Last Name:JOBE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2533 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3158
Mailing Address - Country:US
Mailing Address - Phone:318-688-1040
Mailing Address - Fax:318-688-3039
Practice Address - Street 1:2533 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE 107
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3158
Practice Address - Country:US
Practice Address - Phone:318-688-1040
Practice Address - Fax:318-688-3039
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA-38371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice