Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 29062 | CA |
NPI | 1114041993 |
---|---|
Provider Name | Dr. Harold L Jacobson III |
First Address | El Cajon, CA 92020 |
Second Address | El Cajon, CA 92020-5207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |