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Individual
MR. TAD JACOBS
Active
Individual
MR. TAD JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1258
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1258
DAKOTACARE
SD
01
—
12967
MIDLANDS CHOICE
SD
01
—
4995979
BCBS OF SOUTH DAKOTA
SD
05
—
5602006
—
SD
05
—
5602007
—
SD
01
—
57028A004
WPS TRICARE
SD
01
—
659S 6JA
CC SYSTEMS BLUE PLUS
MN
01
—
659S6JA
BCBS OF MN
MN
01
—
68890
ARAZ/AMERICA'S PPO
SD
05
—
873765700
—
MN
01
—
AH908107523
PREFERRED ONE
SD
Enumeration date
02/23/2006
Last updated
07/08/2016
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