Organization
ROLAND W. JACOBS, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROLAND W. JACOBS M.D. (PRESIDENT)
(575) 770-7892
Entity
Organization
Contact information
Practice address
156 CERRITO-COLORADO RD., VALDEZ, NM 87580
(575) 770-7892
(575) 776-2922
Mailing address
PO BOX 459, ARROYO SECO, NM 87514-0459
(575) 770-7892
(575) 776-2922
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
91225
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80077226
—
NM
01
—
W18090
MEDICARE PTAN
CA
Enumeration date
08/07/2006
Last updated
02/18/2014
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