Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | R71393 | AZ |
N | 208600000X | Surgeon | R71393 | AZ |
Y | 2086S0127X | Trauma Surgeon | 50084 | AZ |
NPI | 1215160379 |
---|---|
Provider Name | Dr. Jordan Vernon Jacobs |
First Address | Phoenix, AZ 85012-2716 |
Second Address | Phoenix, AZ 85013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2009 |
Last Update Date | 16/07/2019 |