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General NPI Number Information
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NPI Number | 1619107273
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Entity Type | Individual
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Provider Name | JANIE LOUISE JACOBS M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 07/29/2013
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Provider Practice Location Address
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Address Line | 303 N KEENE ST SUITE 404
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City | COLUMBIA
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State | MO
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Zip | 65201-7193
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Country | US
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Telephone | 573-777-7627
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Fax | 573-777-4596
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Provider Business Mailing Address
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Address Line | 2100 CHERRY HILL DR APT 202
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City | COLUMBIA
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State | MO
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Zip | 65203-5923
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Country | US
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Telephone | 910-722-6812
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2013017670
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License Number State | MO
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