Provider Demographics
NPI:1750455259
Name:JACOBS, STEVEN JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JEFFREY
Last Name:JACOBS
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 1:9001 WILSHIRE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1840
Mailing Address - Country:US
Mailing Address - Phone:310-271-2328
Mailing Address - Fax:310-271-3793
Practice Address - Street 1:9001 WILSHIRE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1840
Practice Address - Country:US
Practice Address - Phone:310-271-2328
Practice Address - Fax:310-271-3793
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45704207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG-457040Medicaid
CAA92594Medicare UPIN
CAG-457040Medicaid