Jacobs, Richard Allen

Jacobs, Richard Allen is an sole proprietor health care provider with primary practice located at 619 S Washington St Ste 202, Moscow ID 83843-3090. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Jacobs, Richard Allen can be contacted via phone (208) 882-1522.

Contact Information

Primary practice address
619 S Washington St Ste 202 Moscow ID 83843-3090
Fax: (208) 882-1527
Website:

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X M3665 Idaho

Profile Details

NPI number 1457333668
LBN Legal business name Jacobs, Richard Allen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 15th, 2005
Last updated Jun 28th, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457333668 NPPES
Idaho Other 362964260 TAX ID

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