Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 12123 | DC |
Y | 207T00000X | Neurosurgeon | D29422 | MD |
NPI | 1104893015 |
---|---|
Provider Name | Dr. Jeff Jacobson |
First Address | Bethesda, MD 20814 |
Second Address | Bethesda, MD 20814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 23/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C62761 | (02) |