| Doctor Name: | KALEB LYDON JACOBS |
| NPI Number: | 1124468129 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | R-34-2015 |
| Business Practice Address: | 530 Ne Glen Oak Ave Sfnb Rm 2645 (c/o Karen Canning) Peoria, IL - 61637 |
| Business Phone Number: | 3123888083 |
| Business Fax Number: | 3096553739 |
| Mailing Address: | 530 Ne Glen Oak Ave, Sfnb Rm 2645 (c/o Karen Canning) PEORIA |
| State: | IL |
| Postal Code: | 61637 |
| Phone Number: | 3123888083 |
| Fax Number: | 3096553739 |
| NPI Enumeration Date: | 07/05/2013 |
| NPI Last Update Date: | 01/05/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | R-34-2015 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NM |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |