Provider Demographics
NPI:1790887388
Name:CHRISTIAN, JACOB CHARLES (DO)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:CHARLES
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 HEARTLAND RD STE 2800
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-6201
Mailing Address - Country:US
Mailing Address - Phone:816-271-1200
Mailing Address - Fax:816-271-1220
Practice Address - Street 1:901 HEARTLAND RD
Practice Address - Street 2:SUITE 2800
Practice Address - City:ST. JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3398
Practice Address - Country:US
Practice Address - Phone:816-271-1244
Practice Address - Fax:816-271-1220
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2007001552207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200605660AMedicaid
MO39927012OtherBLUE CROSS BLUE SHIELD
KS42600018OtherBLUE CROSS BLUE SHIELD
1790887388Medicare PIN