Provider Demographics
NPI:1164458907
Name:JACOBS, JONATHAN T (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:T
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 1:5701 W 119TH ST STE 419
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3721
Mailing Address - Country:US
Mailing Address - Phone:913-498-1444
Mailing Address - Fax:913-667-2759
Practice Address - Street 1:5701 W 119TH ST STE 419
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3721
Practice Address - Country:US
Practice Address - Phone:913-498-1444
Practice Address - Fax:913-667-2759
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0429916208M00000X, 207R00000X
MO2002028986207R00000X, 208000000X, 208M00000X
KS04-29916207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics