Provider Demographics
NPI:1063737914
Name:HARTER, JACOB LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:LAWRENCE
Last Name:HARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 BATH ST # 113
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4339
Mailing Address - Country:US
Mailing Address - Phone:805-682-7744
Mailing Address - Fax:
Practice Address - Street 1:2320 BATH ST # 113
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4339
Practice Address - Country:US
Practice Address - Phone:805-682-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1178022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology