Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 27529 | CA |
NPI | 1194745844 |
---|---|
Provider Name | Dr. Theodore Eric Jacobson |
First Address | San Francisco, CA 94108-4206 |
Second Address | San Francisco, CA 94108-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |