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Individual

DR. BLAKE JACOBS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3800 S NATIONAL AVE STE 510, SPRINGFIELD, MO 65807-5284
(417) 875-3160
Mailing address
PO BOX 7411626, CHICAGO, IL 60674-5626

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2025013440
OK
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
2025013440
MO

Other

Enumeration date
05/23/2017
Last updated
09/10/2025
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