Individual
JOHN P JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1401 CHESTER BLVD, RICHMOND, IN 47374-1908
(765) 983-3168
(765) 983-3275
Mailing address
225 E NORTH ST APT 505, INDIANAPOLIS, IN 46204-1334
(317) 955-9747
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
01045864
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000588411
ANTHEM PIN
IN
01
—
100194370
GROUP MEDICAID
IN
01
—
1487680518
GROUP NPI
IN
05
—
200109120
—
IN
01
—
200288740
GROUP MEDICAID
IN
Enumeration date
08/19/2005
Last updated
12/22/2008
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