Provider Demographics
NPI:1063686707
Name:JAMES D. JACOBITZ, M.D. INC.
Entity Type:Organization
Organization Name:JAMES D. JACOBITZ, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JACOBITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-337-7546
Mailing Address - Street 1:190 EUCALYPTUS DR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1629
Mailing Address - Country:US
Mailing Address - Phone:415-337-3546
Mailing Address - Fax:415-337-7547
Practice Address - Street 1:190 EUCALYPTUS DR
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1629
Practice Address - Country:US
Practice Address - Phone:415-337-3546
Practice Address - Fax:415-337-7547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG10697207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G106970OtherMEDICARE PT NUMBER
CAA38044Medicare UPIN
CA00G106970Medicare PIN