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General NPI Number Information
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NPI Number | 1760443659
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Entity Type | Individual
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Provider Name | DAVID JACOBSON JR. PA
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Gender | Male
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Dates
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Enumeration Date | 03/30/2006
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Last Update Date | 11/15/2018
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Provider Practice Location Address
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Address Line | 36000 EUCLID AVE
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City | WILLOUGHBY
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State | OH
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Zip | 44094
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Country | US
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Telephone | 440-953-6203
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Fax | 440-953-6202
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Provider Business Mailing Address
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Address Line | 7381 WILLOW RUN DR
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City | MENTOR
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State | OH
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Zip | 44060-3529
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Country | US
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Telephone | 440-413-0877
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 022384-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50000362
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License Number State | OH
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