Individual
RICHARD R JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2801 CLEARWATER CT, JOPLIN, MO 64801-8239
(732) 233-0640
Mailing address
1865 ADMIRAL CT, GLENVIEW, IL 60026-8055
(702) 582-7540
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
01067878A
IN
2085R0001X
Radiation Oncology Physician
Primary
036117769
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000705885
ANTHEM PROVIDER NUMBER
IN
01
—
0432464
STATE LICENSE
KS
05
—
201014850
—
IN
01
—
2SMA06320300
STATE LICENSE
NJ
Enumeration date
06/27/2007
Last updated
04/17/2018
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