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General NPI Number Information
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NPI Number | 1174524136
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Entity Type | Individual
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Provider Name | JEFFREY MARK JACOBS M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 201 S 14TH ST
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City | HERRIN
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State | IL
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Zip | 62948-3631
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Country | US
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Telephone | 618-942-2171
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Fax | 618-988-6166
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Provider Business Mailing Address
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Address Line | 2501 COMPASS RD SUITE 130
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City | GLENVIEW
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State | IL
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Zip | 60026-8000
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Country | US
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Telephone | 847-677-1170
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Fax | 847-677-1233
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 036092245
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License Number State | IL
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