Provider Demographics
NPI:1184675100
Name:JACOBS, DAVID JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JONATHAN
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8002 DISCOVERY DR RM 410
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-8601
Mailing Address - Country:US
Mailing Address - Phone:804-287-4213
Mailing Address - Fax:804-282-4048
Practice Address - Street 1:400 WESTHAMPTON STA
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3330
Practice Address - Country:US
Practice Address - Phone:804-287-4200
Practice Address - Fax:804-287-4256
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND11985207W00000X, 207WX0107X
VA0101268576207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist