Individual
WELLS C JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
36 HAYNES ST, MANCHESTER, CT 06040-4105
(860) 646-0188
(860) 645-9573
Mailing address
36 HAYNES ST, MANCHESTER, CT 06040-4105
(860) 646-0188
(860) 645-9573
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
022276
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001222769
—
CT
Enumeration date
04/14/2006
Last updated
02/24/2009
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