Individual
DR. PETER C JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1849 OLD DONATION PKWY, VIRGINIA BEACH, VA 23454-3004
(757) 422-8476
(757) 213-4332
Mailing address
1115 BOULDERS PKWY STE 200, NORTH CHESTERFIELD, VA 23225-4067
(804) 560-5595
(804) 560-9029
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
0101041104
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6409628
—
VA
Enumeration date
07/25/2006
Last updated
09/02/2020
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