Individual
DR. JACOB JOSEPH TOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
960 N 16TH ST STE 103, SPRINGFIELD, OR 97477-4175
(541) 726-4694
(541) 744-6069
Mailing address
696 N SHEPHERD RD, WASHOUGAL, WA 98671-8320
(360) 281-6432
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
39631
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287539
—
OR
Enumeration date
02/21/2006
Last updated
06/08/2011
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