Provider Demographics
NPI:1023192101
Name:JACOBSON, LESTER B (MD)
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:B
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 CLAY ST
Mailing Address - Street 2:SUITE 513F
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2382
Mailing Address - Country:US
Mailing Address - Phone:415-923-3565
Mailing Address - Fax:415-923-3564
Practice Address - Street 1:2351 CLAY ST
Practice Address - Street 2:SUITE 513F
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2382
Practice Address - Country:US
Practice Address - Phone:415-923-3565
Practice Address - Fax:415-923-3564
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15026207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0714817Medicaid
00G150260Medicare PIN
A39411Medicare UPIN