Individual
DR. BRUCE E. JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
205 MAIN ST, LUZERNE, PA 18709
(570) 459-9730
(570) 459-9736
Mailing address
105 PERRIN AVE APT A, SHAVERTOWN, PA 18708-1453
(570) 901-1749
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS008757L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001571274
—
PA
Enumeration date
03/21/2006
Last updated
06/05/2018
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