Individual
RICHARD JACOBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9191 GRANT ST, THORNTON, CO 80229-4361
(719) 537-0712
Mailing address
PO BOX 150, HOLLY, CO 81047-0150
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
18008
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01180082
—
CO
Enumeration date
06/21/2006
Last updated
07/08/2007
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