Provider Demographics
NPI:1003895962
Name:JACOBS, JAMES H JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:JACOBS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12368 STRATFORD DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8162
Mailing Address - Country:US
Mailing Address - Phone:515-226-9810
Mailing Address - Fax:515-961-2714
Practice Address - Street 1:12368 STRATFORD DR
Practice Address - Street 2:SUITE 300
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8162
Practice Address - Country:US
Practice Address - Phone:515-226-9810
Practice Address - Fax:515-961-2714
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2013-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN335462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN668214600Medicaid
MNF12224Medicare UPIN
MN300002617Medicare ID - Type Unspecified