Provider Demographics
NPI:1780654053
Name:JACOBS, JOHN BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BENJAMIN
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9755 W STATE HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:RATCLIFF
Mailing Address - State:AR
Mailing Address - Zip Code:72951-9000
Mailing Address - Country:US
Mailing Address - Phone:479-635-5300
Mailing Address - Fax:479-635-2010
Practice Address - Street 1:9755 W STATE HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:RATCLIFF
Practice Address - State:AR
Practice Address - Zip Code:72951-9000
Practice Address - Country:US
Practice Address - Phone:479-635-5300
Practice Address - Fax:479-635-2010
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC7933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1670799OtherUNITED HEALTHCARE
AR7959093OtherAETNA INSURANCE COMPANY
ARXX12984OtherHEALTH PLUS OF MICHIGAN
AR020407900OtherBLACK LUNG PROGRAM
AR0790780001OtherPALMETTO GBA
AR375018OtherHEALTH LINK
AR0062731OtherUMWA H&R FUNDS
AR080046831OtherRAILROAD MEDICARE/PALMETT
AR123744001Medicaid
AR55027OtherBLUECROSSBLUESHIELD ARK
AR15346000000OtherQUALCHOICE
AR020407900OtherBLACK LUNG PROGRAM
AR1670799OtherUNITED HEALTHCARE