Provider Demographics
NPI:1346701422
Name:LEGER, JACOB DAMIEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:DAMIEN
Last Name:LEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DEQUINCY
Mailing Address - State:LA
Mailing Address - Zip Code:70633-3301
Mailing Address - Country:US
Mailing Address - Phone:337-786-6161
Mailing Address - Fax:337-786-7999
Practice Address - Street 1:601 W 4TH ST
Practice Address - Street 2:
Practice Address - City:DEQUINCY
Practice Address - State:LA
Practice Address - Zip Code:70633-3301
Practice Address - Country:US
Practice Address - Phone:337-786-6161
Practice Address - Fax:337-786-7999
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA323520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2496336Medicaid