Healthcare Provider Details

I. General information

NPI: 1699459917
Provider Name (Legal Business Name): BENJAMIN NATHANIEL JACOBS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 A AVE NE
CEDAR RAPIDS IA
52402-5036
US

IV. Provider business mailing address

1026 A AVE NE
CEDAR RAPIDS IA
52402-5036
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR-12930
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: