Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 00049044 | WA |
N | 208600000X | Surgeon | 00049044 | WA |
N | 208200000X | Surgeon | A55944 | CA |
N | 208600000X | Surgeon | A55944 | CA |
N | 2086S0102X | Surgical Critical Care | 000449044 | WA |
N | 2086S0102X | Surgical Critical Care | A55944 | CA |
N | 2086S0127X | Trauma Surgeon | 00049044 | WA |
Y | 2086S0127X | Trauma Surgeon | A55944 | CA |
NPI | 1255332227 |
---|---|
Provider Name | Dr. Robert Charles Jacoby |
First Address | Vacaville, CA 95688-9494 |
Second Address | Vacaville, CA 95688-9494 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 11/02/2022 |