Provider Demographics
NPI:1215160379
Name:JACOBS, JORDAN VERNON (MD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:VERNON
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 33269
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-3269
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:500 W THOMAS RD STE 400
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4238
Practice Address - Country:US
Practice Address - Phone:480-406-3874
Practice Address - Fax:602-406-2335
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2024-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ500842086S0127X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery