| Doctor Name: | DR. RICHARD MARC JACOBS |
| NPI Number: | 1114955564 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.P.M. |
| License Number: | 952 |
| Business Practice Address: | 4511 Knox Rd Suite 103 College Park, MD - 207403380 |
| Business Phone Number: | 3017790355 |
| Business Fax Number: | 3019277036 |
| Mailing Address: | 4511 Knox Rd, Suite 103 COLLEGE PARK |
| State: | MD |
| Postal Code: | 207403380 |
| Phone Number: | 3017790355 |
| Fax Number: | 3019277036 |
| NPI Enumeration Date: | 06/28/2006 |
| NPI Last Update Date: | 12/07/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 952 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MD |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |