Individual
WILLIAM A JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2550 ADDISON AVE E, SUITE B, TWIN FALLS, ID 83301-6749
(208) 814-7700
(208) 933-9301
Mailing address
PO BOX 587, TWIN FALLS, ID 83303-0587
(208) 814-7400
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-494
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806903300
—
ID
Enumeration date
08/02/2006
Last updated
10/03/2012
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