Individual
DR. ALICIA A JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
883 BLAKELY RD, COLCHESTER, VT 05446-4417
(802) 847-2055
Mailing address
883 BLAKELY RD, COLCHESTER, VT 05446-4417
(802) 847-2055
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0420009645
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02212146
—
NY
05
—
OVN2031
—
VT
Enumeration date
07/11/2006
Last updated
08/26/2011
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