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Individual

NORMAN M JACOBS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1805 27TH ST, SOMC, PORTSMOUTH, OH 45662
(740) 356-8117
(740) 353-1214
Mailing address
1735 27TH ST STE B06, PORTSMOUTH, OH 45662-2681
(740) 356-6942
(740) 356-7851

Taxonomy

Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
35050302
OH
2085R0202X
Diagnostic Radiology Physician
Primary
35050302
OH
2085R0202X
Diagnostic Radiology Physician
51107
KY
2085R0202X
Diagnostic Radiology Physician
MC-177
GU

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000203530
BC/BS INDIVIDUAL PIN NO
OH
05
0635389
OH
05
6478787200
KY
01
P00176289
SOM RR MDCR PIN NUMBER
OH
01
TP318
KENTUCKY MEDICAL LICENSE
KY
Enumeration date
07/22/2005
Last updated
09/19/2023
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