MEDICARE: JULIE DORIS 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
1	207QA0505X	Adult Medicine Physician	22374	CO
2	207QA0505X	Adult Medicine Physician	4301052531	MI
3	207QA0505X	Adult Medicine Physician	G39969	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1376819433	OTHER	CA	NPI

General Provider Information

NPI Number	:	1376819433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE DORIS JACOBS MD

Provider Business Mailing Address
First Line	:	2300 STOCKTON BLVD STE 1700
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2202
Country	:	US
Telephone Number	:	800-282-3284
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 STOCKTON BLVD STE 1700
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2202
Country	:	US
Telephone Number	:	800-282-3284
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2012
Last Update Date	:	04/20/2021

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