Provider Demographics
NPI:1699757286
Name:JACOBS, DONALD J (MD)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:J
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-0549
Mailing Address - Country:US
Mailing Address - Phone:906-774-1313
Mailing Address - Fax:906-776-5639
Practice Address - Street 1:1711 S STEPHENSON AVE STE 125
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3649
Practice Address - Country:US
Practice Address - Phone:906-776-5810
Practice Address - Fax:906-228-0218
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2020-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301022733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0802243952OtherBCBS MI
WI31333300Medicaid
MI3010109Medicaid
MI080079313OtherRR MEDICARE
WI31333300Medicaid
MI0B26002024Medicare PIN