Healthcare Provider Details

I. General information

NPI: 1730288317
Provider Name (Legal Business Name): ROBYN HAYLEY JACOBS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD SUITE 3015B
ST LOUIS MO
63141-8244
US

IV. Provider business mailing address

621 S NEW BALLAS RD SUITE 3015B
ST LOUIS MO
63141-8244
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6344
  • Fax: 314-251-7929
Mailing address:
  • Phone: 314-251-6344
  • Fax: 314-251-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberR4J40
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: