Provider Demographics
NPI:1962822718
Name:CARL, JACOB RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:RYAN
Last Name:CARL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 8500 LOCKBOX 7642
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:813-281-8115
Mailing Address - Fax:813-281-8656
Practice Address - Street 1:911 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2901
Practice Address - Country:US
Practice Address - Phone:509-455-7844
Practice Address - Fax:509-623-0415
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-20
Last Update Date:2020-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD61088190207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty