Healthcare Provider Details

I. General information

NPI: 1447255005
Provider Name (Legal Business Name): TAMAYO S JACOBS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3406 BROADWAY BLVD STE B
KANSAS CITY MO
64111-2767
US

IV. Provider business mailing address

3406 BROADWAY BLVD STE B
KANSAS CITY MO
64111-2767
US

V. Phone/Fax

Practice location:
  • Phone: 816-756-5839
  • Fax: 816-756-5874
Mailing address:
  • Phone: 816-756-5839
  • Fax: 816-756-5874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2011023454
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2011023454
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number04-27686
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: