Provider Demographics
NPI:1609204924
Name:JACOBS, MERLE W (MD)
Entity Type:Individual
Prefix:
First Name:MERLE
Middle Name:W
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 1:3021 OLD ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-6685
Mailing Address - Country:US
Mailing Address - Phone:217-222-6858
Mailing Address - Fax:
Practice Address - Street 1:3021 OLD ORCHARD RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-6685
Practice Address - Country:US
Practice Address - Phone:217-222-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336-007504207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology