Provider Demographics
NPI:1508305574
Name:WILLIAM A. JACOBSON, M.D.
Entity Type:Organization
Organization Name:WILLIAM A. JACOBSON, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-241-0080
Mailing Address - Street 1:15203 11TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3737
Mailing Address - Country:US
Mailing Address - Phone:760-241-0088
Mailing Address - Fax:760-241-0091
Practice Address - Street 1:15203 11TH ST STE D
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3737
Practice Address - Country:US
Practice Address - Phone:760-241-0080
Practice Address - Fax:760-241-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA18012261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982655494OtherINDIVIDUAL NPI NUMBER