Provider Demographics
NPI:1922193143
Name:JACOKES, DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:JACOKES
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 1:4309 EMPEROR BLVD
Mailing Address - Street 2:STE 125
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8045
Mailing Address - Country:US
Mailing Address - Phone:919-941-0158
Mailing Address - Fax:919-474-3130
Practice Address - Street 1:4309 EMPEROR BLVD
Practice Address - Street 2:STE 125
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8045
Practice Address - Country:US
Practice Address - Phone:919-941-0158
Practice Address - Fax:919-474-3130
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35381207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF22628Medicare UPIN