MEDICARE: JEFFERY JACOBS M.D.

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	207P00000X	Emergency Medicine Physician	33092	IA
2	207P00000X	Emergency Medicine Physician	21795	NE
3	207Q00000X	Family Medicine Physician	21795	NE

General Provider Information

NPI Number	:	1740229384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY JACOBS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 642117
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-8117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8613 N 30TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68112-1852
Country	:	US
Telephone Number	:	402-453-9900
Fax Number	:	402-453-5617

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/20/2011

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