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General NPI Number Information
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NPI Number | 1720030349
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Entity Type | Individual
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Provider Name | JOSEPH JACOB
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 08/16/2010
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Provider Practice Location Address
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Address Line | 150 S MOUNT AUBURN RD STE 344
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-4910
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Country | US
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Telephone | 573-331-5515
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Fax | 573-331-5516
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Provider Business Mailing Address
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Address Line | PO BOX 843225
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City | KANSAS CITY
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State | MO
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Zip | 64184-3225
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Country | US
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Telephone | 708-633-1234
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Fax | 708-342-7100
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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 | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 36615
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License Number State | MO
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