Provider Demographics
NPI:1619107273
Name:JACOBS, JANIE LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANIE
Middle Name:LOUISE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2100 CHERRY HILL DR
Mailing Address - Street 2:APT 202
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5923
Mailing Address - Country:US
Mailing Address - Phone:910-722-6812
Mailing Address - Fax:
Practice Address - Street 1:303 N KEENE ST
Practice Address - Street 2:SUITE 404
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7193
Practice Address - Country:US
Practice Address - Phone:573-777-7627
Practice Address - Fax:573-777-4596
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2013017670208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics