Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 35.048988 | OH |
N | 111NI0900X | Internist | 35.048988 | OH |
Y | 207U00000X | Nuclear Medicine Specialist | 35.048988 | OH |
NPI | 1659327534 |
---|---|
Provider Name | Martin P Jacobs |
First Address | Kettering, OH 45429-8796 |
Second Address | Kettering, OH 45429-1221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 15/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0629921 | (05) | OH |
360003354 | MEDICARE RAILROAD (01) | |
A15714 | (02) |