Individual
BRENT A JACOBUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
9150 E 109TH AVE STE 2A, CROWN POINT, CROWN POINT, IN 46307-7686
(219) 226-1529
(219) 226-2994
Mailing address
9150 E 109TH AVE STE 2A, CROWN POINT, CROWN POINT, IN 46307-7686
(219) 226-1529
(219) 226-2994
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02001090
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100200720
—
IN
Enumeration date
08/09/2005
Last updated
11/01/2011
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