Basic Information
| Provider Information | |||||||||
| NPI: | 1750525416 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STINSON | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1719 CLARENDON DR | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274102928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072173139 | ||||||||
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| Practice Location | |||||||||
| Address1: | 930 3RD ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274056967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368903200 | ||||||||
| FaxNumber: | 3368903290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2009 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DO2187 | ME | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | ME | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 2012-01185 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.