Individual
ERIC DUDLEY JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
809 WEST STETSON AVENUE SUITE B, APEX RADIOLOGY MEDICAL GROUP, INC, HEMET, CA 92543
(951) 537-6002
Mailing address
809 WEST STETSON AVENUE, SUITE B, HEMET, CA 92543
(951) 537-6002
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G63250
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G632500
—
CA
01
—
00G632501
MEDICARE PTAN
CA
01
—
00G632502
MEDICARE PTAN
CA
01
—
300116419
RAILROAD
CA
01
—
300116433
RAILROAD
CA
01
—
300116435
RAILROAD
CA
Enumeration date
06/16/2006
Last updated
02/28/2013
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