Provider Demographics
NPI:1932224490
Name:JACOBS, STANLEY WINSTONJ (MD,FRCS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:WINSTONJ
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD,FRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 FOSS CREEK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448
Mailing Address - Country:US
Mailing Address - Phone:707-473-0220
Mailing Address - Fax:
Practice Address - Street 1:145 FOSS CREEK CIR.
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448
Practice Address - Country:US
Practice Address - Phone:707-473-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65799174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist