J. Bruce Jacobs, MD, Inc

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

A21604 Issued in CA

Legal business name

J. BRUCE JACOBS, MD, INC

Practice address

11525 Brookshire Ave
Suite 111
Downey, CA 90241-4985

Phone

(562) 904-1111

Fax

(562) 861-6666

NPI assigned

Dec 13, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Alexander Usmanov, M.D.

Title

President

Phone

(562) 904-1111

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• DOWNEY RADIOLOGY Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1292198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390867200000",
    "number": "1215230297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11525 BROOKSHIRE AVE",
            "address_2": "SUITE 111",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902414985",
            "telephone_number": "562-904-1111",
            "fax_number": "562-861-6666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11525 BROOKSHIRE AVE",
            "address_2": "SUITE 111",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902414985",
            "telephone_number": "562-904-1111",
            "fax_number": "562-861-6666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. BRUCE JACOBS, MD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-13",
        "last_updated": "2014-01-28",
        "status": "A",
        "authorized_official_last_name": "USMANOV",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "562-904-1111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A21604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215230297",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DOWNEY RADIOLOGY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Diagnostic Radiology Physician in Downey, CA
• Providers in Downey, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.