Paul Allen Jacobson, M.D.
Individual provider Active NPI Family Medicine Physician · Angels Camp, CA
NPI 1720114598 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1720114598
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- C35556 (CA)
- Practice address
- 1300 Kurt Dr
Suite 104
Angels Camp, CA 95222 - Phone
- (209) 736-6750
- Fax
- (209) 736-6750
- NPI assigned
- Feb 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | C35556 | CA | Yes |
Addresses
Primary practice location
1300 Kurt Dr
Suite 104
Angels Camp, CA 95222
Mailing address
PO Box 1048
Angels Camp, CA 95222-1048
Phone (209) 736-6750
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00C355560 | Medicaid | CA |
Other providers in Angels Camp, CA
- Gabriella Rose Gomez Hawkins
- Robert Shelby Haymond
- Star Hildabrand
- Kyrstyn Hildreth
- Chris H. Iwata
- Priya Tara Johnston
- Laura Camille Jones
- Kelli Marie Karr
- Christopher James Krpan
- John Brennan Krpan
All providers in Angels Camp, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.