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General NPI Number Information
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NPI Number | 1467485607
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Entity Type | Individual
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Provider Name | GREGORY T JACOBS DO
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Gender | Male
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 09/26/2014
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Provider Practice Location Address
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Address Line | 600 MARY ST
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City | EVANSVILLE
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State | IN
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Zip | 47710-1674
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Country | US
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Telephone | 812-450-3405
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Fax | 812-450-3099
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Provider Business Mailing Address
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Address Line | PO BOX 3407
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City | EVANSVILLE
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State | IN
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Zip | 47733-3407
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Country | US
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Telephone | 812-450-3405
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Fax | 812-450-3099
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 10648
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 02003898A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 02993
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License Number State | KY
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