Individual
MARY ANNE JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6545 FRANCE AVENUE SOUTH, SUITE 540, EDINA, MN 55435
(952) 927-4045
(952) 924-4133
Mailing address
6545 FRANCE AVENUE SOUTH, SUITE 540, EDINA, MN 55435
(952) 927-4045
(952) 924-4133
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
41934
MN
207VE0102X
Reproductive Endocrinology Physician
41934
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11D21JA
BLUE CROSS/BLUE SHIELD
MN
05
—
252025700
—
MN
01
—
HP29251
HEALTH PARTNERS
MN
Enumeration date
03/01/2006
Last updated
04/04/2016
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