Individual
MR. DONALD J JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1711 S STEPHENSON AVE STE 125, IRON MOUNTAIN, MI 49801-3649
(906) 776-5810
(906) 228-0218
Mailing address
PO BOX 549, IRON MOUNTAIN, MI 49801-0549
(906) 774-1313
(906) 776-5639
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301022733
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080079313
RR MEDICARE
MI
01
—
0802243952
BCBS MI
MI
05
—
3010109
—
MI
05
—
31333300
—
WI
Enumeration date
11/18/2005
Last updated
01/06/2020
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