Provider Demographics
NPI:1104244300
Name:STEIN, JACOB N (MD)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:N
Last Name:STEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2730 S VAL VISTA DR
Mailing Address - Street 2:SUITE 152
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295
Mailing Address - Country:US
Mailing Address - Phone:480-471-8560
Mailing Address - Fax:888-979-8197
Practice Address - Street 1:12424 N 32ND ST STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7156
Practice Address - Country:US
Practice Address - Phone:480-471-8560
Practice Address - Fax:888-979-8197
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ564022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program