Individual
EDWIN LAWRENCE JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
181 S BUENA VISTA ST, 4RTH FLOOR, BURBANK, CA 91505-4504
(818) 840-0921
(818) 840-7064
Mailing address
PO BOX 51194, LOS ANGELES, CA 90051-5494
(818) 840-0921
(818) 840-7064
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
G62813
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OOG628130
—
CA
Enumeration date
07/19/2006
Last updated
04/10/2012
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