Provider Demographics
NPI:1164529038
Name:JACOBS, CHERYL R (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:R
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15214 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6143
Mailing Address - Country:US
Mailing Address - Phone:206-518-9021
Mailing Address - Fax:206-299-0987
Practice Address - Street 1:15214 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-6143
Practice Address - Country:US
Practice Address - Phone:206-518-9021
Practice Address - Fax:206-299-0987
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1200JAOtherREGENCE
WA8244931Medicaid
WA214488OtherLABOR & INDUSTRY
WA5891740001OtherDME
WAP00385271OtherPALMETTO RR MEDICARE
WA214488OtherLABOR & INDUSTRY
WAP00385271OtherPALMETTO RR MEDICARE