Provider Demographics
NPI:1598790024
Name:JACOBS, COREY DUANE (MD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:DUANE
Last Name:JACOBS
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 1:1550 ELK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8322
Mailing Address - Country:US
Mailing Address - Phone:208-529-4243
Mailing Address - Fax:208-693-4756
Practice Address - Street 1:1550 ELK CREEK DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8322
Practice Address - Country:US
Practice Address - Phone:208-529-5942
Practice Address - Fax:208-529-5951
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-15890207V00000X
AL27305207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009938418Medicaid
ID808198200Medicaid
ID20022468OtherMEDICARE
AL51539428OtherBC AL