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NPI Code Detail

MEDICARE: JACOB DWIGHT EVERETT DO

MEDICARE: JACOB DWIGHT EVERETT DO
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
1390200000XStudent in an Organized Health Care Education/Training ProgramSL2190NV

General Provider Information

NPI Number : 1184483810
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB DWIGHT EVERETT DO
Provider Business Mailing Address
First Line : 2880 N TENAYA WAY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0618
Country : US
Telephone Number : 702-427-6398
Fax Number :
Provider Business Practice Location Address
First Line : 2880 N TENAYA WAY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0618
Country : US
Telephone Number : 702-427-6398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2024
Last Update Date : 05/10/2026

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