Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | MD039905E | PA |
NPI | 1255347977 |
---|---|
Provider Name | Dr. Thomas C Jacob JR. |
First Address | Media, PA 19063-5136 |
Second Address | Media, PA 19063-5136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 21/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F48513 | (02) | PA |