Individual
RICHARD ALBERT JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2728 SUNSET BLVD STE 400, WEST COLUMBIA, SC 29169-4839
(803) 936-7095
(803) 936-7908
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2671
SC
Other
Enumeration date
11/04/2016
Last updated
11/06/2020
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