Provider Demographics
NPI:1922018472
Name:JOBE, BRIAN CARL (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:CARL
Last Name:JOBE
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 1:101 EVANRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71302-2102
Mailing Address - Country:US
Mailing Address - Phone:318-442-8958
Mailing Address - Fax:
Practice Address - Street 1:101 EVANRIDGE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71302-2102
Practice Address - Country:US
Practice Address - Phone:318-442-8958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022288208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1675971Medicaid
LA5W597F600Medicare ID - Type Unspecified
LA1675971Medicaid