Provider Demographics
NPI:1245333186
Name:JACOBS, ALAN K (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:K
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 ELIZABETH PL
Mailing Address - Street 2:SUITE 210 WEST MEDICAL PLAZA
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3445
Mailing Address - Country:US
Mailing Address - Phone:937-495-0000
Mailing Address - Fax:937-495-0140
Practice Address - Street 1:1 ELIZABETH PL
Practice Address - Street 2:SUITE 210 WEST MEDICAL PLAZA
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3445
Practice Address - Country:US
Practice Address - Phone:937-495-0000
Practice Address - Fax:937-495-0140
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350461482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0499910Medicaid
OHJA4072831Medicare ID - Type Unspecified
OHC02107Medicare UPIN