Individual
DR. RICHARD ALLEN JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
619 S WASHINGTON ST, STE 202, MOSCOW, ID 83843-3090
(208) 882-1522
(208) 882-1527
Mailing address
619 S. WASHINGTON ST., STE 202, MOSCOW, ID 83843-0000
(208) 882-1522
(208) 882-1527
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M3665
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
362964260
TAX ID
ID
Enumeration date
11/15/2005
Last updated
06/28/2010
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