Provider Demographics
NPI:1124134374
Name:JOBE, TINA MARIE (MD)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:JOBE
Suffix:
Gender:F
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:PO BOX 24023
Mailing Address - Street 2:DEPT 03-019
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-4023
Mailing Address - Country:US
Mailing Address - Phone:662-665-0457
Mailing Address - Fax:662-665-0458
Practice Address - Street 1:401 ALCORN DR STE 1E
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9071
Practice Address - Country:US
Practice Address - Phone:662-665-0457
Practice Address - Fax:662-665-0458
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19157207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I50073Medicare UPIN
MS050000832Medicare ID - Type Unspecified