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NPI Code Detail

MEDICARE: BRIAN ANTHONY JACOBS MD

MEDICARE: BRIAN ANTHONY JACOBS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician01044402IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437240694
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN ANTHONY JACOBS MD
Provider Business Mailing Address
First Line : 6301 UNIVERSITY COMMONS
Second Line : STE 210
City : SOUTH BEND
State : IN
Zip : 46635-1590
Country : US
Telephone Number : 574-239-4602
Fax Number : 574-239-4607
Provider Business Practice Location Address
First Line : 6301 UNIVERSITY COMMONS STE 210
Second Line :
City : SOUTH BEND
State : IN
Zip : 46635-1590
Country : US
Telephone Number : 574-234-4016
Fax Number : 574-239-4607
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 05/31/2024

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