Provider Demographics
NPI:1346362894
Name:JACOB, DONALD JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JAMES
Last Name:JACOB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8169 OAK LEAF LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2856
Mailing Address - Country:US
Mailing Address - Phone:716-639-8011
Mailing Address - Fax:716-639-7590
Practice Address - Street 1:6161 TRANSIT RD
Practice Address - Street 2:SUITE 6
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2606
Practice Address - Country:US
Practice Address - Phone:716-688-6161
Practice Address - Fax:716-636-5084
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176605-4B202C00000X
NY176605207R00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYY78562Medicare ID - Type Unspecified
NYC87512Medicare UPIN