Individual
DR. ADDISON F JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
310 W LOSEY ST, SCOTT AIR FORCE BASE, IL 62225-5250
(618) 256-9355
Mailing address
310 W LOSEY ST, SCOTT AIR FORCE BASE, IL 62225-5250
(618) 256-9355
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
036178029
IL
2085R0202X
Diagnostic Radiology Physician
2026006949
MO
2085R0202X
Diagnostic Radiology Physician
Primary
33917
NE
208D00000X
General Practice Physician
33917
NE
Other
Enumeration date
03/13/2020
Last updated
03/18/2026
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