Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | G52767 | CA |
NPI | 1023028446 |
---|---|
Provider Name | Robert Jacobs |
First Address | Oceanside, CA 92056-4454 |
Second Address | Oceanside, CA 92056-4454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 27/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G527670 | (05) | CA |
00G527670 | BLUE SHIELD (01) | CA |
E02721 | (02) | CA |
WG52767A | (02) | CA |