Provider Demographics
NPI:1689420937
Name:LEWIS, JACOB D JR
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:D
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 FLORIDA AVE APT C
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2189
Mailing Address - Country:US
Mailing Address - Phone:504-292-8824
Mailing Address - Fax:
Practice Address - Street 1:4109 FLORIDA AVE APT C
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2189
Practice Address - Country:US
Practice Address - Phone:504-292-8824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-27
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)