Provider Demographics
NPI:1447593066
Name:STANLEY JACOBS, M.D. INC
Entity Type:Organization
Organization Name:STANLEY JACOBS, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:M,D,
Authorized Official - Phone:707-473-0220
Mailing Address - Street 1:PO BOX 6671
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95406-0671
Mailing Address - Country:US
Mailing Address - Phone:707-433-0220
Mailing Address - Fax:707-473-0990
Practice Address - Street 1:145 FOSS CREEK CIR
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-4288
Practice Address - Country:US
Practice Address - Phone:707-473-0220
Practice Address - Fax:707-473-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65799208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty