Provider Demographics
NPI:1528048659
Name:JACOBSON, JOHN GARTH (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GARTH
Last Name:JACOBSON
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 1:6 WOODLAND RD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-9501
Mailing Address - Country:US
Mailing Address - Phone:707-963-6303
Mailing Address - Fax:707-963-1492
Practice Address - Street 1:6 WOODLAND RD
Practice Address - Street 2:SUITE #101
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9501
Practice Address - Country:US
Practice Address - Phone:707-963-6303
Practice Address - Fax:707-963-1492
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22916208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G229160Medicaid
CA00G229160Medicaid
CAA41772Medicare UPIN