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Individual
MARK JACOBS
Active
Individual
MARK JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
15-01583
KS
363A00000X
Physician Assistant
Primary
PA.1502
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1017889
NCCPA
—
05
—
9500618500
—
KY
01
—
PA12419
STATE PA LICENSE
CA
Enumeration date
08/29/2006
Last updated
04/04/2024
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