Provider Demographics
NPI:1871681809
Name:JACOBS, LEE A (DO)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:A
Last Name:JACOBS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:4 ROSSI CIR
Mailing Address - Street 2:SUITE 141
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93907-2362
Mailing Address - Country:US
Mailing Address - Phone:831-757-4444
Mailing Address - Fax:831-757-4419
Practice Address - Street 1:591 MCCRAY ST
Practice Address - Street 2:STE. 101
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-2224
Practice Address - Country:US
Practice Address - Phone:831-634-4444
Practice Address - Fax:831-634-4440
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-12-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA2OA5950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A59502Medicare PIN
CAF50349Medicare UPIN