Individual
DR. THEODORE R JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 HARDY RD # 220, BEDFORD, NH 03110-4915
(603) 472-4711
Mailing address
1 HARDY RD # 220, BEDFORD, NH 03110-4915
(603) 472-4711
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
64835
GA
207T00000X
Neurological Surgery Physician
Primary
8619
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003106197A
—
GA
Enumeration date
10/13/2005
Last updated
02/28/2014
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