04D0953662 CLIA NUMBER - JOB JACOB, M D, P L L C

Laboratory Demographics

CLIA Number: 04D0953662

Facility Name: JOB JACOB, M D, P L L C

Facility Address:
965 CARSON COVE, SUITE A
CONWAY, AR
ZIP 72034
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Facility Phone Number: 501 513-2628

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1053377101

Taxonomy: 207RG0100X - Internal Medicine
An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.

CLIA Record

Field Name	Field Value
CLIA Number	04D0953662
LAB Type	Physician Office
Facility Name	JOB JACOB, M D, P L L C
Street	965 CARSON COVE, SUITE A
City	CONWAY
State	AR
ZIP	72034
Phone	501 513-2628
CertificateType	4
CertificateEffectiveDate	11/6/2022
CertificateExpirationDate	11/5/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024