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Individual

DR. WILLIAM M. JACOBS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
8405 E. BASELINE RD., SUITE 107, MESA, AZ 85209
(480) 615-2010
(480) 218-6053
Mailing address
8405 E. BASELINE RD., SUITE 107, MESA, AZ 85209
(480) 615-2010
(480) 218-6053

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0101030878
VA
208000000X
Pediatrics Physician
Primary
38147
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
102616
AZ
05
6737846
VA
Enumeration date
10/26/2006
Last updated
12/17/2012
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