Provider Demographics
NPI:1447379672
Name:JACOBS, ERIC F (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:F
Last Name:JACOBS
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 1:102 E FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:DEQUINCY
Mailing Address - State:LA
Mailing Address - Zip Code:70633-3502
Mailing Address - Country:US
Mailing Address - Phone:337-786-3030
Mailing Address - Fax:337-786-6066
Practice Address - Street 1:102 E FOURTH ST
Practice Address - Street 2:
Practice Address - City:DEQUINCY
Practice Address - State:LA
Practice Address - Zip Code:70633-3502
Practice Address - Country:US
Practice Address - Phone:337-786-3030
Practice Address - Fax:337-786-6066
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08646R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1921718Medicaid
LA1921718Medicaid
5N642Medicare ID - Type Unspecified