Dr Randolph J Jacobs, MD is a medicare enrolled "Dermatology" physician in Wildomar, California. His current practice location is
23905 Clinton Keith Rd Ste 114, Wildomar, California. You can reach out to his office (for appointments etc.) via phone at
(951) 672-7673.
Dr Randolph J Jacobs is licensed to practice in California (license number G61654) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1417975905.
Physician's Profile
| Full Name | Dr Randolph J Jacobs |
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| Gender | Male |
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| Speciality | Dermatology |
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| Location | 23905 Clinton Keith Rd Ste 114, Wildomar, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1417975905
- Provider Enumeration Date: 07/17/2006
- Last Update Date: 03/12/2008
Medicare PECOS Information:
- PECOS PAC ID: 3072696533
- Enrollment ID: I20080515000667
Medical Identifiers
Medical identifiers for Dr Randolph J Jacobs such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1417975905 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 207N00000X | Dermatology | G61654 (California) | Primary |
| 207NI0002X | Dermatology - Clinical & Laboratory Dermatological Immunology | G61654 (California) | Secondary |
| 207ND0900X | Dermatology - Dermatopathology | G61654 (California) | Secondary |
| 207ND0101X | Dermatology - Mohs-micrographic Surgery | G61654 (California) | Secondary |
| 207NP0225X | Dermatology - Pediatric Dermatology | G61654 (California) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Randolph J Jacobs is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Dr Randolph J Jacobs, MD 23905 Clinton Keith Rd Ste 114, Wildomar, CA 92595-7899 Ph: (951) 672-7673 | Dr Randolph J Jacobs, MD 23905 Clinton Keith Rd Ste 114, Wildomar, CA 92595-7899 Ph: (951) 672-7673 |
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