Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 2853 | NC |
NPI | 1548498439 |
---|---|
Provider Name | Dr. Willie Ray Jacobs |
First Address | Red Springs, NC 28377-8403 |
Second Address | Red Springs, NC 28377-8403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2009 |
Last Update Date | 14/01/2022 |