Provider Demographics
NPI:1568213668
Name:MANSFIELD, JACOB JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:JOHN
Last Name:MANSFIELD
Suffix:
Gender:M
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:DEPARTMENT OF INTERNAL MEDICINE, 30 E. APPLE STREET
Mailing Address - Street 2:6TH FLOOR, MAGNOLIA PLACE
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409
Mailing Address - Country:US
Mailing Address - Phone:707-365-5530
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF INTERNAL MEDICINE, 30 E. APPLE STREET
Practice Address - Street 2:6TH FLOOR, MAGNOLIA PLACE
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409
Practice Address - Country:US
Practice Address - Phone:707-365-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.256586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine