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Individual
JACOB IBROOK TOWER
Active
Individual
JACOB IBROOK TOWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
288000
MA
207YS0123X
Facial Plastic Surgery Physician
Primary
288000
MA
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
303409
NY
Other
Enumeration date
05/19/2015
Last updated
04/26/2023
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