Provider Demographics
NPI:1518947308
Name:JACOBY, GEOFFREY SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:SAMUEL
Last Name:JACOBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NBHC SASEBO
Mailing Address - Street 2:PSC 476 BOX 25
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96322
Mailing Address - Country:US
Mailing Address - Phone:18195-650-2551
Mailing Address - Fax:
Practice Address - Street 1:NBHC SASEBO
Practice Address - Street 2:PSC 476 BOX 25
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96322
Practice Address - Country:US
Practice Address - Phone:18195-650-2551
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101840396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine