Provider Demographics
NPI:1730807603
Name:MCNAMARA, JACOB MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:MICHAEL
Last Name:MCNAMARA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3980 LAKERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-5199
Mailing Address - Country:US
Mailing Address - Phone:907-360-1950
Mailing Address - Fax:
Practice Address - Street 1:3980 LAKERIDGE CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-5199
Practice Address - Country:US
Practice Address - Phone:907-360-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program