Provider Demographics
NPI:1124438163
Name:JACOBS, DEANNE RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:DEANNE
Middle Name:RENEE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEANNE
Other - Middle Name:RENEE
Other - Last Name:DU VAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1380 NW WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-1208
Mailing Address - Country:US
Mailing Address - Phone:513-737-3690
Mailing Address - Fax:513-737-3698
Practice Address - Street 1:1380 NW WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-1208
Practice Address - Country:US
Practice Address - Phone:513-737-3690
Practice Address - Fax:513-737-3698
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01077379A208600000X
OH35.151176208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery