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General NPI Number Information
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NPI Number | 1124783774
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Entity Type | Individual
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Provider Name | JACOB HEISER PA
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Gender | Male
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Dates
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Enumeration Date | 11/08/2021
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 1113 S STATE ST STE 202
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City | DOVER
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State | DE
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Zip | 19901-4112
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Country | US
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Telephone | 302-261-5600
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Fax | 302-450-3181
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Provider Business Mailing Address
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Address Line | 1113 S STATE ST STE 202
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City | DOVER
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State | DE
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Zip | 19901-4112
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Country | US
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Telephone | 302-261-5600
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Fax | 302-450-3181
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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