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NPI Code Detail

MEDICARE: MR. JACOB MICHAEL ALEXANDER PA-C

MEDICARE: MR. JACOB MICHAEL ALEXANDER PA-C
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
1171000000XMilitary Health Care Provider
2363AM0700XMedical Physician Assistant0010-11056NC

General Provider Information

NPI Number : 1518440411
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JACOB MICHAEL ALEXANDER PA-C
Provider Business Mailing Address
First Line : 2817 ROCK MERRITT AVE
Second Line :
City : FORT BRAGG
State : NC
Zip : 28310-0001
Country : US
Telephone Number : 910-907-8922
Fax Number : 910-907-6069
Provider Business Practice Location Address
First Line : 3551 ROGER BROOKE DR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78234-4504
Country : US
Telephone Number : 910-494-4977
Fax Number : 210-539-2273
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2018
Last Update Date : 06/29/2026

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