Individual
MR. EDDIE JACOBO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
C51396
MD
1744P3200X
Prosthetics Case Management
C51396
MD
332BC3200X
Customized Equipment (DME)
Primary
C51396
MD
Other
Enumeration date
06/08/2015
Last updated
06/08/2015
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