Provider Demographics
NPI:1043448608
Name:JAKUBOWSKI, JULIAN ADAM JOHN (DO)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:ADAM JOHN
Last Name:JAKUBOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:401 MATTHEW ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1635
Practice Address - Country:US
Practice Address - Phone:740-376-1939
Practice Address - Fax:740-374-1693
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243361207P00000X
UT79252871204207P00000X
OH34010559207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810023412Medicaid
OH0067141Medicaid
OHP01216338OtherRAILROAD MEDICARE
WV3810023412Medicaid