Jacobson, Charles D
Jacobson, Charles D is an individual health care provider with primary practice located at 1701 3Rd St Se , Puyallup WA 98372-4511. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Jacobson, Charles D can be contacted via phone (253) 967-5767.Contact Information
Primary practice address
1701 3Rd St Se
Puyallup WA 98372-4511
Phone: (253) 967-5767
Fax: (253) 697-5682
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | MD00013535 | Washington |
Profile Details
| NPI number | 1124092754 |
|---|---|
| LBN Legal business name | Jacobson, Charles D |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 13th, 2006 |
| Last updated | Nov 8th, 2011 - about 14 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124092754 | NPPES |
| Washington | Other | 111661110 | MEDICARE OTHER-INDIVIDUAL |
| Washington | MEDICAID | 1414200 | MEDICARE OTHER-INDIVIDUAL |
| Washington | Other | CO3401 | MEDICARE OTHER-INDIVIDUAL |
| Washington | Other | 193400000X | MEDICARE OTHER-INDIVIDUAL |
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