Provider Demographics
NPI:1932382793
Name:ROBERT JACOBS MD PC
Entity Type:Organization
Organization Name:ROBERT JACOBS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-320-2822
Mailing Address - Street 1:4545 E 9TH AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3901
Mailing Address - Country:US
Mailing Address - Phone:303-320-2822
Mailing Address - Fax:
Practice Address - Street 1:4545 E 9TH AVE
Practice Address - Street 2:STE 400
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3901
Practice Address - Country:US
Practice Address - Phone:303-320-2822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14578207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04012449Medicaid
CO112042009OtherRRW MEDICARE
E05956Medicare UPIN
COCOA100393Medicare PIN