Individual
DR. MARILYN ELIZABETH JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
105 S BROADWAY ST, SUITE 730, WICHITA, KS 67202-4227
(316) 393-9933
Mailing address
105 S BROADWAY ST, SUITE 730, WICHITA, KS 67202-4227
(316) 393-9933
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
04-32354
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200426290A
—
KS
Enumeration date
05/03/2007
Last updated
12/09/2013
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