Provider Demographics
NPI:1073574539
Name:JACOBS, STUART I (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:I
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5345 N EL DORADO ST
Mailing Address - Street 2:STE 12
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5872
Mailing Address - Country:US
Mailing Address - Phone:209-957-6662
Mailing Address - Fax:209-957-0310
Practice Address - Street 1:5345 N EL DORADO ST
Practice Address - Street 2:STE 12
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5872
Practice Address - Country:US
Practice Address - Phone:209-957-6662
Practice Address - Fax:209-957-0310
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA00G30790207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAJ7067665OtherDEA
CA00G307900Medicare ID - Type Unspecified
CAAJ7067665OtherDEA