Provider Demographics
NPI:1538367990
Name:JACKS, TOBIN EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:TOBIN
Middle Name:EUGENE
Last Name:JACKS
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 1:403 E MONTGOMERY ST
Mailing Address - Street 2:SOUTH APT
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-2026
Mailing Address - Country:US
Mailing Address - Phone:641-828-2126
Mailing Address - Fax:
Practice Address - Street 1:403 E MONTGOMERY ST
Practice Address - Street 2:SOUTH APT
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-2026
Practice Address - Country:US
Practice Address - Phone:641-828-2126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26026207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine