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General NPI Number Information
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NPI Number | 1780113886
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Entity Type | Individual
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Provider Name | JACOB WILLIAM THOMAS DO
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Gender | Male
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Dates
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Enumeration Date | 06/12/2017
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 300 TUSKEGEE BLVD
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City | DOVER AIR FORCE BASE
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State | DE
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Zip | 19902-5003
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Country | US
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Telephone | 302-677-6527
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Fax | 26-776-5273
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Provider Business Mailing Address
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Address Line | 300 TUSKEGEE BLVD
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City | DOVER AIR FORCE BASE
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State | DE
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Zip | 19902-5003
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Country | US
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Telephone | 26-776-5273
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 125071136
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 7286321
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License Number State | WI
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