Individual
DR. JONATHAN S JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.,M.D.,F.A.C.S.
Contact information
Practice address
1037 FIRST COLONIAL RD, VIRGINIA BEACH, VA 23454-3037
(757) 491-3535
(757) 422-4750
Mailing address
1037 FIRST COLONIAL RD, VIRGINIA BEACH, VA 23454-3037
(757) 491-3535
(757) 422-4750
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
0101030062
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101030062
MEDICAL LICENSE
VA
05
—
7601972
—
VA
01
—
C06224
MEDICARE GROU
VA
Enumeration date
08/21/2006
Last updated
08/27/2010
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