Healthcare Provider Details

I. General information

NPI: 1063686707
Provider Name (Legal Business Name): JAMES D. JACOBITZ, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 EUCALYPTUS DR
SAN FRANCISCO CA
94132-1629
US

IV. Provider business mailing address

190 EUCALYPTUS DR
SAN FRANCISCO CA
94132-1629
US

V. Phone/Fax

Practice location:
  • Phone: 415-337-3546
  • Fax: 415-337-7547
Mailing address:
  • Phone: 415-337-3546
  • Fax: 415-337-7547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberG10697
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG10697
License Number StateCA

VIII. Authorized Official

Name: DR. JAMES DAVID JACOBITZ
Title or Position: DOCTOR
Credential: M.D.
Phone: 415-337-7546