Individual
DR. MARK DAVID JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5555 RESERVOIR DR STE 104, SAN DIEGO, CA 92120-5198
(619) 286-6930
(619) 286-9438
Mailing address
5555 RESERVOIR DR STE 104, SAN DIEGO, CA 92120-5198
(619) 286-6930
(619) 286-9438
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G71151
CA
207XS0106X
Orthopaedic Hand Surgery Physician
G71151
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G711510
—
CA
01
—
990010759
MEDICARE RR
CA
Enumeration date
11/06/2006
Last updated
12/06/2018
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