Healthcare Provider Details

I. General information

NPI: 1962194209
Provider Name (Legal Business Name): ZACHARY THOMAS JACOBS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 N HIGH ST STE C
DUBLIN OH
43017-6148
US

IV. Provider business mailing address

53 N HIGH ST STE C
DUBLIN OH
43017-6148
US

V. Phone/Fax

Practice location:
  • Phone: 614-344-7601
  • Fax:
Mailing address:
  • Phone: 614-344-7601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: