Individual
DR. RICHARD MICHAEL JACOBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 GARDEN VIEW CT STE 204, ENCINITAS, CA 92024-2478
(760) 452-6334
(760) 349-9755
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 343-9800
(704) 347-2011
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
9400849
NC
207RI0011X
Interventional Cardiology Physician
9400849
NC
207RI0011X
Interventional Cardiology Physician
Primary
G161416
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053353029
NPPES
CA
01
—
45580
BCBS
NC
05
—
8945580
—
NC
05
—
N00849
—
SC
01
—
P00612426
RAILROAD MEDICARE
NC
Enumeration date
06/12/2006
Last updated
10/29/2019
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