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General NPI Number Information
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NPI Number | 1477500288
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Entity Type | Individual
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Provider Name | RICHARD WESLEY JACOBSON MD
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Gender | Male
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 1 SAINT MARY PL
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City | SHREVEPORT
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State | LA
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Zip | 71101-4343
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Country | US
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Telephone | 318-681-4222
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Fax | 318-681-6114
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Provider Business Mailing Address
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Address Line | ONE ST. MARY PLACE
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City | SHREVEPORT
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State | LA
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Zip | 71101
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Country | US
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Telephone | 318-681-4222
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Fax | 318-681-6114
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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 | MD.15048R
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License Number State | LA
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