Individual
MYRON H JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11133 DUNN RD, SUITE 2335, SAINT LOUIS, MO 63136-6119
(314) 653-5007
(314) 653-4149
Mailing address
11133 DUNN RD, SUITE 2335, SAINT LOUIS, MO 63136-6119
(314) 653-5007
(314) 653-4149
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
R3942
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110154795
RR MEDICARE PCI
MO
05
—
200233203
—
MO
01
—
29006738
RR MEDICARE PSC
MO
Enumeration date
11/02/2005
Last updated
02/10/2026
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