MEDICARE: DR. LON JACOBUS TAFF M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	C54503	CA

General Provider Information

NPI Number	:	1548254295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LON JACOBUS TAFF M.D.

Provider Business Mailing Address
First Line	:	1723 11TH AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-4140
Country	:	US
Telephone Number	:	916-764-5627
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 BRUCEVILLE RD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-4671
Country	:	US
Telephone Number	:	916-764-5627
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	02/11/2022

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