Individual
DR. BRYAN JOHN JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3333 W TECH RD STE 220, MIAMISBURG, OH 45342-0956
(937) 885-4475
(937) 885-3670
Mailing address
PO BOX 933432, CLEVELAND, OH 44193-0039
(937) 641-5072
(937) 641-6129
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
29116
NE
208000000X
Pediatrics Physician
Primary
35.151519
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0121663
—
OH
Enumeration date
06/12/2014
Last updated
02/24/2025
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