Provider Demographics
NPI:1780647875
Name:JACOBS, SCOTT E (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
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 1:1155 MILL ST # MCM14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:901 E 2ND ST
Practice Address - Street 2:STE 307
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1178
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-3901
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7789207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1780647875Medicaid
11040710OtherCAQH
01WCHJA44Medicare ID - Type Unspecified
11040710OtherCAQH