Individual
JACOB P SCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4100 LAKE DR SE, SUITE 200, GRAND RAPIDS, MI 49546-8292
(616) 267-8244
(616) 267-7272
Mailing address
100 MICHIGAN ST NE, MC845, GRAND RAPIDS, MI 49503-2560
(616) 486-6557
(616) 486-6702
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
50966
MN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
4301097324
MI
207RP1001X
Pulmonary Disease Physician
4301097324
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033309380
—
MI
05
—
ENROLLED
—
MN
01
—
P00746352
MEDIICARE, RAILROAD
MN
Enumeration date
08/01/2007
Last updated
05/20/2024
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