Individual
WAYNE R JACOBS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
435 RIVER AVE, WILLIAMSPORT, PA 17701-3722
(866) 995-3937
Mailing address
66 ENTERPRISE BLVD, ALLENWOOD, PA 17810-9260
(570) 538-6002
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA061359
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103739681
—
PA
Enumeration date
01/06/2020
Last updated
01/07/2021
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