Provider Demographics
NPI:1972658771
Name:JACOBS, JAMES R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
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 1:411 FALLS BLVD S
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-3501
Mailing Address - Country:US
Mailing Address - Phone:870-238-3261
Mailing Address - Fax:870-238-3115
Practice Address - Street 1:411 FALLS BLVD S
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-3501
Practice Address - Country:US
Practice Address - Phone:870-238-3261
Practice Address - Fax:870-238-3115
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102032001Medicaid
AR52617Medicare PIN
ARC68573Medicare UPIN