Provider Demographics
NPI:1043321094
Name:JACOBS, ANDREW D (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:D
Last Name:JACOBS
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 1:1100 9TH AVE
Mailing Address - Street 2:MS M4-PA
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-583-6025
Mailing Address - Fax:206-515-5886
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031448207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8153769Medicaid
WAJA5907OtherBLUE SHIELD
830005116OtherRAILROAD MEDICARE
WAUS0899710OtherAETNA/USHC SPECIALIST
WA0039582OtherLABOR & INDUSTRY
WAMD843WAOtherALASKA MEDICAID
WA804187200OtherIDAHO MEDICAID
WAUS0818750OtherAETNA/USHC PCP
WA8153769Medicaid
WAUS0899710OtherAETNA/USHC SPECIALIST
E90348Medicare UPIN