Provider Demographics
NPI:1730288317
Name:JACOBS, ROBYN HAYLEY (MD)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:HAYLEY
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 3015B
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8244
Mailing Address - Country:US
Mailing Address - Phone:314-251-6344
Mailing Address - Fax:314-251-7929
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 3015B
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8244
Practice Address - Country:US
Practice Address - Phone:314-251-6344
Practice Address - Fax:314-251-7929
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4J40207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E88483Medicare UPIN