Provider Demographics
NPI:1841327210
Name:JACOBSON, STUART ANDREW (MD FACC)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:ANDREW
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:DR
Other - First Name:STUART
Other - Middle Name:ANDREW
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD FACC
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:400 NE MOTHER JOSEPH PL
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3200
Practice Address - Country:US
Practice Address - Phone:360-514-4724
Practice Address - Fax:360-514-6530
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3897207RC0000X
WAMD61549359207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132470903Medicaid
F57885Medicare UPIN