Provider Demographics
NPI:1063614477
Name:JACOBSON, RICHARD HARVEY (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HARVEY
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 1:3939 NUUANU PALI DR
Mailing Address - Street 2:#E
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1000
Mailing Address - Country:US
Mailing Address - Phone:808-595-2118
Mailing Address - Fax:
Practice Address - Street 1:1100 WARD AVE
Practice Address - Street 2:SUITE 1070
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1600
Practice Address - Country:US
Practice Address - Phone:808-548-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-51632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry