Provider Demographics
NPI:1407169345
Name:JACOBS, ALAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 ORTEGA CT
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4451
Mailing Address - Country:US
Mailing Address - Phone:650-575-5260
Mailing Address - Fax:650-230-7130
Practice Address - Street 1:3721 ORTEGA CT
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-4451
Practice Address - Country:US
Practice Address - Phone:650-575-5260
Practice Address - Fax:650-230-7130
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG083705208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice