Individual
GREGORY T JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
600 MARY ST, EVANSVILLE, IN 47710-1674
(812) 450-3405
(812) 450-3099
Mailing address
PO BOX 3407, EVANSVILLE, IN 47733-3407
(812) 450-3405
(812) 450-3099
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02003898A
IN
207P00000X
Emergency Medicine Physician
02993
KY
207P00000X
Emergency Medicine Physician
10648
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200844060
—
IN
05
—
64127962
—
KY
Enumeration date
07/09/2006
Last updated
09/26/2014
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