Provider Demographics
NPI:1568502136
Name:CARMICHAEL, JACOB JONAS (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:JONAS
Last Name:CARMICHAEL
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 1:34800 BOB WILSON DR
Mailing Address - Street 2:C/O PULMONARY MEDICINE
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1098
Mailing Address - Country:US
Mailing Address - Phone:619-532-5990
Mailing Address - Fax:619-532-7625
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:C/O PULMONARY MEDICINE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1098
Practice Address - Country:US
Practice Address - Phone:619-532-5990
Practice Address - Fax:619-532-7625
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0431507207R00000X, 207RP1001X, 207RC0200X
NMMD2023-1334207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease