Healthcare Provider Details

I. General information

NPI: 1982099412
Provider Name (Legal Business Name): CORBIN DANIEL JACOBS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 E MULLAN AVE
POST FALLS ID
83854-9064
US

IV. Provider business mailing address

1204 N VERCLER RD
SPOKANE VALLEY WA
99216-1020
US

V. Phone/Fax

Practice location:
  • Phone: 509-228-1000
  • Fax: 509-252-9300
Mailing address:
  • Phone: 509-228-1000
  • Fax: 509-252-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number61047154
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number15172
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: