Individual
JOSEPH JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
150 S MOUNT AUBURN RD, STE 344, CAPE GIRARDEAU, MO 63703-4910
(573) 331-5515
(573) 331-5516
Mailing address
PO BOX 843225, KANSAS CITY, MO 64184-3225
(708) 633-1234
(708) 342-7100
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
36615
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
160306001
—
AR
01
—
188833
HEALTHLINK
—
05
—
203568324
—
MO
01
—
444830
ANTHEM BCBS
MO
01
—
P00262024
RAILROAD MEDICARE
—
Enumeration date
05/16/2006
Last updated
08/16/2010
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