Provider Demographics
NPI:1326362294
Name:JACOBS, SARAH MIRELES (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:MIRELES
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 ADAMS ST SE
Mailing Address - Street 2:STE 130
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3751
Mailing Address - Country:US
Mailing Address - Phone:256-265-7863
Mailing Address - Fax:
Practice Address - Street 1:910 ADAMS ST SE
Practice Address - Street 2:STE 130
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3751
Practice Address - Country:US
Practice Address - Phone:256-265-7863
Practice Address - Fax:256-265-7965
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014008611207W00000X
ALAL35979207WX0200X
WAMD60539268207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicaid
WA1326362294Medicaid