Provider Demographics
NPI:1205898483
Name:JACOBS, RONNIE L (MD)
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:L
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 1:78 CRESTRIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803
Mailing Address - Country:US
Mailing Address - Phone:828-681-9876
Mailing Address - Fax:
Practice Address - Street 1:123 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2868
Practice Address - Country:US
Practice Address - Phone:828-257-4730
Practice Address - Fax:828-257-4738
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC009300160207R00000X
SCTL29367207R00000X
VA0101231028207R00000X
MDD0061172207R00000X
GA055244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC110229261OtherRAILROAD MEDICARE
NC45590OtherBCBS
NC8945590Medicaid
NC2213347EMedicare ID - Type Unspecified
NCG06459Medicare UPIN
NC8945590Medicaid
NC8945590Medicaid
VA00W952P04Medicare ID - Type Unspecified
NC2213347EMedicare ID - Type Unspecified
NC45590OtherBCBS
VA00X085P02Medicare ID - Type Unspecified
NC22133470Medicare ID - Type Unspecified