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1740320761

NPI Code Detail

MEDICARE: DR. WILLIAM R JACOBS MD

MEDICARE: DR. WILLIAM R 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	207R00000X	Internal Medicine Physician	38987	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	110167665	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0452683	OTHER		UNITED HEALTHCARE
2	047483026	OTHER		TRICARE
3	0197680	OTHER		CIGNA
5	73823	OTHER	NC	BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	30160	OTHER		MEDCOST

General Provider Information

NPI Number	:	1740320761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM R JACOBS MD

Provider Business Mailing Address
First Line	:	PO BOX 18563
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27619-8563
Country	:	US
Telephone Number	:	919-782-1806
Fax Number	:	919-782-1669

Provider Business Practice Location Address
First Line	:	3521 HAWORTH DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-7216
Country	:	US
Telephone Number	:	919-782-1806
Fax Number	:	919-782-4756

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	01/29/2009

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Directions to “ DR. WILLIAM R JACOBS MD” Practice Location

Language	Start Address	Practice Location

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