Provider Demographics
NPI:1033849336
Name:GREEN, JACOB J (DO)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:J
Last Name:GREEN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1001 WATERDAM PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2466
Mailing Address - Country:US
Mailing Address - Phone:724-969-1001
Mailing Address - Fax:724-260-5448
Practice Address - Street 1:1001 WATERDAM PLAZA DR
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2466
Practice Address - Country:US
Practice Address - Phone:724-969-1001
Practice Address - Fax:724-260-5448
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2025-10-21
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Provider Licenses
StateLicense IDTaxonomies
PAOS025061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine