MEDICARE: ROBERT J 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
1	207Q00000X	Family Medicine Physician	013707	ME

Other Identifiers

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

General Provider Information

NPI Number	:	1730143405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J JACOBS MD

Provider Business Mailing Address
First Line	:	42 DALLAS HILL RD
Second Line	:
City	:	RANGELEY
State	:	ME
Zip	:	04970
Country	:	US
Telephone Number	:	207-864-3303
Fax Number	:	207-864-2969

Provider Business Practice Location Address
First Line	:	42 DALLAS HILL RD
Second Line	:
City	:	RANGELEY
State	:	ME
Zip	:	04970
Country	:	US
Telephone Number	:	207-864-3303
Fax Number	:	207-864-2969

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	10/12/2012

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