Individual
DR. EDWARD CORNELIOUS JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10 SOUTHMOOR CIR NW, KETTERING, OH 45429-2486
(937) 294-1489
(937) 297-6468
Mailing address
1 PRESTIGE PL, SUITE 550, MIAMISBURG, OH 45342-3794
(937) 752-2305
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
014971
ME
174400000X
Specialist
32702
MA
174400000X
Specialist
35-07-3367-J
OH
174400000X
Specialist
G16625
CA
208800000X
Urology Physician
Primary
35073367
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2033007
—
OH
Enumeration date
07/18/2005
Last updated
03/05/2015
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