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NPI Code Detail

MEDICARE: DR. MARK DAVID JACOBSON M.D.

MEDICARE: DR. MARK DAVID JACOBSON M.D.
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
1207XS0106XOrthopaedic Hand Surgery PhysicianG71151CA
2207X00000XOrthopaedic Surgery PhysicianG71151CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2990010759OTHERCAMEDICARE RR

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 : 1760551915
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK DAVID JACOBSON M.D.
Provider Business Mailing Address
First Line : 5555 RESERVOIR DR STE 104
Second Line :
City : SAN DIEGO
State : CA
Zip : 92120-5198
Country : US
Telephone Number : 619-286-6930
Fax Number : 619-286-9438
Provider Business Practice Location Address
First Line : 5555 RESERVOIR DR STE 104
Second Line :
City : SAN DIEGO
State : CA
Zip : 92120-5198
Country : US
Telephone Number : 619-286-6930
Fax Number : 619-286-9438
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 12/06/2018

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Directions to “ DR. MARK DAVID JACOBSON M.D.” Practice Location

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