Individual
DR. GORDON W JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14920 WYNDHAM OAKS DR, CHARLOTTE, NC 28277-1512
(704) 543-8236
Mailing address
14920 WYNDHAM OAKS DR, CHARLOTTE, NC 28277-1512
(704) 543-8236
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
33382
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130799
—
SC
05
—
89-45688
—
NC
Enumeration date
03/13/2007
Last updated
07/08/2007
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