Individual
IVAN RICHARD JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8501 WILSHIRE BLVD, STE 316, BEVERLY HILLS, CA 90211-3128
(310) 652-2255
(310) 652-2039
Mailing address
8501 WILSHIRE BLVD, STE 316, BEVERLY HILLS, CA 90211-3128
(310) 652-2255
(310) 652-2039
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
C27493
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C274930
BLUE SHIELD
CA
05
—
00C274930
—
CA
Enumeration date
06/09/2005
Last updated
09/25/2008
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