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General NPI Number Information
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NPI Number | 1396068748
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Entity Type | Individual
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Provider Name | JACOBY LYNN ALLEN D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 1253 NW CANAL BLVD
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City | REDMOND
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State | OR
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Zip | 97756-1334
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Country | US
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Telephone | 541-548-8131
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Fax | 541-526-6608
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Provider Business Mailing Address
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Address Line | 155 N FRESNO ST
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City | FRESNO
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State | CA
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Zip | 93701-2302
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Country | US
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Telephone | 559-499-6440
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 20A11126
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License Number State | CA
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