| Doctor Name: | DR. EDWARD CORNELIOUS JACOBS |
| NPI Number: | 1255330676 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | G16625 |
| Business Practice Address: | 10 Southmoor Cir Nw Kettering, OH - 454292486 |
| Business Phone Number: | 9372941489 |
| Business Fax Number: | 9372976468 |
| Mailing Address: | 1 Prestige Pl, Suite 550 MIAMISBURG |
| State: | OH |
| Postal Code: | 453423794 |
| Phone Number: | 9377522305 |
| Fax Number: | |
| NPI Enumeration Date: | 07/18/2005 |
| NPI Last Update Date: | 03/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | G16625 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |