Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME 103069 | FL |
Y | 207X00000X | Orthopaedic Surgeon | ME103069 | FL |
N | 208200000X | Surgeon | RT 1712 | NH |
N | 208600000X | Surgeon | RT 1712 | NH |
N | 208D00000X | General Practice Physician | ME 103069 | FL |
NPI | 1043417611 |
---|---|
Provider Name | Jacob Riis |
First Address | Tucson, AZ 85707 |
Second Address | Tucson, AZ 85707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 31/08/2020 |