Provider Demographics
NPI:1942349055
Name:JACOBS, JAMES WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
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 1:115 CRESCENTCOMMONS DR STE 250
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8134
Mailing Address - Country:US
Mailing Address - Phone:919-859-9954
Mailing Address - Fax:919-859-9957
Practice Address - Street 1:115 CRESCENTCOMMONS DR STE 250
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8134
Practice Address - Country:US
Practice Address - Phone:919-859-9954
Practice Address - Fax:919-859-9957
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110142291OtherRAILROAD MEDICARE
0452682OtherUNITED HEALTHCARE
60538OtherMEDCOST
8416097OtherCIGNA
NC8945587Medicaid
NC45587OtherBCBS
2208369HMedicare PIN
2208369AMedicare PIN
F98202Medicare UPIN