Provider Demographics
NPI:1326542267
Name:MIGUEL, JACOB PAUL (DO)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:PAUL
Last Name:MIGUEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-2517
Mailing Address - Country:US
Mailing Address - Phone:315-801-8848
Mailing Address - Fax:
Practice Address - Street 1:601 STATE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4208
Practice Address - Country:US
Practice Address - Phone:315-917-9966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329289208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery