Individual
MARTIN P JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 296-7211
Mailing address
PO BOX 292796, KETTERING, OH 45429-8796
(614) 430-5726
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35.048988
OH
207U00000X
Nuclear Medicine Physician
Primary
35.048988
OH
2085R0202X
Diagnostic Radiology Physician
35048988
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0629921
—
OH
01
—
360003354
MEDICARE RAILROAD
—
Enumeration date
05/25/2006
Last updated
10/15/2019
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