Healthcare Provider Details

I. General information

NPI: 1114106945
Provider Name (Legal Business Name): TERESA E. JACOBS, MD, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 112TH AVE NE STE 307
BELLEVUE WA
98004-3759
US

IV. Provider business mailing address

PO BOX 5593
BELFAST ME
04915-5500
US

V. Phone/Fax

Practice location:
  • Phone: 425-278-2250
  • Fax: 425-562-5885
Mailing address:
  • Phone: 425-278-2250
  • Fax: 425-562-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD00029806
License Number StateWA

VIII. Authorized Official

Name: MRS. TERESA ELLEN JACOBS
Title or Position: PRESIDENT
Credential: MD
Phone: 425-278-2250