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General NPI Number Information
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NPI Number | 1447457171
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Entity Type | Individual
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Provider Name | RICHARD R JACOBS MD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | 2801 CLEARWATER CT
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City | JOPLIN
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State | MO
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Zip | 64801-8239
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Country | US
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Telephone | 732-233-0640
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Fax |
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Provider Business Mailing Address
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Address Line | 1865 ADMIRAL CT
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City | GLENVIEW
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State | IL
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Zip | 60026-8055
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Country | US
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Telephone | 702-582-7540
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Fax |
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 036117769
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 01067878A
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License Number State | IN
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