Provider Demographics
NPI:1023115177
Name:JACOBS, ALLEN M (DPM)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:M
Last Name:JACOBS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:6400 CLAYTON RD
Mailing Address - Street 2:STE 402
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1850
Mailing Address - Country:US
Mailing Address - Phone:314-367-6545
Mailing Address - Fax:314-367-7038
Practice Address - Street 1:6400 CLAYTON RD
Practice Address - Street 2:STE 402
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1850
Practice Address - Country:US
Practice Address - Phone:314-367-6545
Practice Address - Fax:314-367-7038
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO000436213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT42812Medicare UPIN
MO0968300001Medicare NSC