Provider Demographics
NPI:1770686958
Name:JACOBS, DARYL L (MD)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:L
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:222 S WOODS MILL RD
Mailing Address - Street 2:SUITE310N
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-576-6700
Mailing Address - Fax:314-576-6520
Practice Address - Street 1:222 S WOODS MILL RD
Practice Address - Street 2:SUITE310N
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-576-6700
Practice Address - Fax:314-576-6520
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2023-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI82112207RI0011X
MOR8F53207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO914634700Medicare ID - Type Unspecified
MOE28911Medicare UPIN