Provider Demographics
NPI:1225298268
Name:JACOBS, RICHARD DOUGLAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DOUGLAS
Last Name:JACOBS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:DOUGLAS
Other - Last Name:JACOBS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4176 W JASPER DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-7226
Mailing Address - Country:US
Mailing Address - Phone:480-730-0125
Mailing Address - Fax:480-730-0125
Practice Address - Street 1:4176 W JASPER DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-7226
Practice Address - Country:US
Practice Address - Phone:480-730-0125
Practice Address - Fax:480-730-0125
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17807207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine