Provider Demographics
NPI:1447339502
Name:JACOBI, JAMES M (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:JACOBI
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:PO BOX 1281
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-1281
Mailing Address - Country:US
Mailing Address - Phone:812-276-1253
Mailing Address - Fax:812-276-1026
Practice Address - Street 1:1600 23RD ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-4704
Practice Address - Country:US
Practice Address - Phone:812-276-1374
Practice Address - Fax:812-276-1026
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1028615207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN202272330AMedicaid
IN150770BMedicare ID - Type Unspecified
INC25203Medicare UPIN