Provider Demographics
NPI:1578648812
Name:JACOBS, GEORGE D (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:D
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:29632 DURHAM DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3409
Mailing Address - Country:US
Mailing Address - Phone:419-754-4883
Mailing Address - Fax:419-754-4883
Practice Address - Street 1:1946 N 13TH ST
Practice Address - Street 2:SUITE 483
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43624-1258
Practice Address - Country:US
Practice Address - Phone:419-254-2115
Practice Address - Fax:419-254-2121
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH350404402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00181927OtherRAILROAD MEDICARE
OHAJ7910448OtherDEA NUMBER