Individual
JACOB JACO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10455 ORTHOPAEDIC DR, NEWBURGH, IN 47630-7955
(812) 424-9291
(812) 421-2722
Mailing address
515 READ ST, EVANSVILLE, IN 47710-1739
(812) 424-9291
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002987A
IN
363A00000X
Physician Assistant
PA2736
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10002987A
STATE LICENSE
IN
05
—
300044870
—
IN
01
—
847950029
MEDICARE
IN
01
—
PA2736
STATE LICENSE
KY
Enumeration date
07/28/2020
Last updated
03/15/2024
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