Individual
DR. MARTIN D JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
652 INTERSTATE PKWY, BRADFORD, PA 16701-2935
(814) 362-4031
Mailing address
652 INTERSTATE PKWY, BRADFORD, PA 16701-2935
(814) 362-4031
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD023198E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006809170001
—
PA
Enumeration date
07/12/2006
Last updated
07/25/2011
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