Jacoby, Russell F

Jacoby, Russell F is an sole proprietor health care provider with primary practice located at 3108 Ponte Morino Drive Palmer Professional Centre Suite 230, Cameron Park CA 95682-5022. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Jacoby, Russell F can be contacted via phone (530) 672-2701.

Contact Information

Primary practice address
3108 Ponte Morino Drive Palmer Professional Centre Suite 230 Cameron Park CA 95682-5022
Phone: (530) 672-2701
Fax: (530) 672-9097
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 32200 Wisconsin
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X G86695 California
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 36071501 Illinois

Profile Details

NPI number 1700852878
LBN Legal business name Jacoby, Russell F
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 27th, 2006
Last updated Feb 4th, 2008 - about 16 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 1700852878 NPPES
Wisconsin MEDICAID 31708100

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