# CLYDE TYRONE JACOB III

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1972504488
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 01089636A | IN | — |
| 207V00000X | Obstetrics & Gynecology Physician | 1999591 | NY | — |
| 207V00000X | Obstetrics & Gynecology Physician | 25MA09347700 | NJ | — |
| 207V00000X | Obstetrics & Gynecology Physician | 81399 | GA | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | C1-0025884 | DE | — |
| 207V00000X | Obstetrics & Gynecology Physician | ME162114 | FL | — |

## Other

- **Enumeration date:** 08/09/2005
- **Last updated:** 12/14/2023