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General NPI Number Information
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NPI Number | 1023123668
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Entity Type | Individual
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Provider Name | JONATHAN S JACOBS D.M.D.,M.D.,F.A.C.S.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 08/27/2010
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Provider Practice Location Address
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Address Line | 1037 FIRST COLONIAL RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3037
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Country | US
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Telephone | 757-491-3535
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Fax | 757-422-4750
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Provider Business Mailing Address
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Address Line | 1037 FIRST COLONIAL RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3037
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Country | US
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Telephone | 757-491-3535
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Fax | 757-422-4750
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 0101030062
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License Number State | VA
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