Provider Demographics
NPI:1669581336
Name:JACOBS, MARC H
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:H
Last Name:JACOBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 MARKET ST
Mailing Address - Street 2:SUITE 1605
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104
Mailing Address - Country:US
Mailing Address - Phone:415-395-9680
Mailing Address - Fax:415-396-9681
Practice Address - Street 1:582 MARKET ST
Practice Address - Street 2:1605
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104
Practice Address - Country:US
Practice Address - Phone:415-395-9680
Practice Address - Fax:415-395-9681
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG323562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG32356OtherMEDICAL BOARD OF CALIFORNIA
CA00G323560Medicaid
CA00G323560Medicare PIN