Healthcare Provider Details

I. General information

NPI: 1891386975
Provider Name (Legal Business Name): JACOB WILLIAM RIGG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 UNION AVE STE 167
DOVER OH
44622-3005
US

IV. Provider business mailing address

515 UNION AVE STE 167
DOVER OH
44622-3005
US

V. Phone/Fax

Practice location:
  • Phone: 330-343-3335
  • Fax:
Mailing address:
  • Phone: 330-343-3335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.006710RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: