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NPI Code Detail

MEDICARE: SERA ANN JACOB DO

MEDICARE: SERA ANN JACOB DO
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
1207Q00000XFamily Medicine PhysicianDOL.OL.61508494WA

General Provider Information

NPI Number : 1821739798
Entity Type Code : Individual
Provider Name (Legal Business Name) : SERA ANN JACOB DO
Provider Business Mailing Address
First Line : 731 N IRON BRIDGE WAY
Second Line :
City : SPOKANE
State : WA
Zip : 99202-4926
Country : US
Telephone Number : 509-444-8888
Fax Number : 509-444-7806
Provider Business Practice Location Address
First Line : 3919 N MAPLE ST
Second Line :
City : SPOKANE
State : WA
Zip : 99205-1349
Country : US
Telephone Number : 509-444-8200
Fax Number : 509-434-0392
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2022
Last Update Date : 12/10/2025

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Directions to “ SERA ANN JACOB DO” Practice Location

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