Healthcare Provider Details

I. General information

NPI: 1477559524
Provider Name (Legal Business Name): PAUL JAKUBEC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 INGLEWOOD BLVD
MORGANTOWN WV
26505-7316
US

IV. Provider business mailing address

1267 WOODRUFF PL
MORGANTOWN WV
26505-2720
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-2004
  • Fax: 304-599-7611
Mailing address:
  • Phone: 304-599-4466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number08988
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: