Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 47004 | MN |
N | 207Q00000X | Family Doctor | OS014838 | PA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | OS014838 | PA |
NPI | 1215915111 |
---|---|
Provider Name | Brian S Jacobs |
First Address | Danville, PA 17822-4903 |
Second Address | Jersey Shore, PA 17740-1729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 05/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102381212 | (05) | PA |
670998200 | (05) | MN |
I18900 | (02) |