Provider Demographics
NPI:1619945326
Name:JACOBS-SHAW, RAMON EDUARDO ACOSTA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:EDUARDO ACOSTA
Last Name:JACOBS-SHAW
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 1:30 W MONROE ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-2420
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:455 SUTTER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-8111
Practice Address - Country:US
Practice Address - Phone:718-765-6550
Practice Address - Fax:347-620-9739
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC149431207R00000X
NY259692207R00000X
NC2006-01278207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904973Medicaid
NC5904973Medicaid