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NPI Code Detail

MEDICARE: EDWARD JACOBS MD

MEDICARE: EDWARD JACOBS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianMD00029257WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104891324
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD JACOBS MD
Provider Business Mailing Address
First Line : PO BOX 5127
Second Line :
City : EVERETT
State : WA
Zip : 98206-5127
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8910 VERNON RD
Second Line :
City : LAKE STEVENS
State : WA
Zip : 98258-2400
Country : US
Telephone Number : 425-335-0966
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2006
Last Update Date : 12/11/2012

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