Provider Demographics
NPI:1801259189
Name:JACOBUS, DYLAN PATRICK (MD)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:PATRICK
Last Name:JACOBUS
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 1:50 UNION ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1534
Mailing Address - Country:US
Mailing Address - Phone:207-664-5642
Mailing Address - Fax:
Practice Address - Street 1:50 UNION ST STE 2200
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1534
Practice Address - Country:US
Practice Address - Phone:207-664-5642
Practice Address - Fax:207-664-5664
Is Sole Proprietor?:No
Enumeration Date:2016-04-03
Last Update Date:2024-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD24406208600000X
WI6401208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery