Doctor Name: | MICHAEL D JACOBSON |
NPI Number: | 1013959188 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 0110002152 |
Business Practice Address: | 2121 E Harmony Rd Suite 300 Fort Collins, CO - 805283400 |
Business Phone Number: | 9702249102 |
Business Fax Number: | 9702249112 |
Mailing Address: | 2121 E Harmony Rd, Suite 300 FORT COLLINS |
State: | CO |
Postal Code: | 805283400 |
Phone Number: | 9702249102 |
Fax Number: | 9702249112 |
NPI Enumeration Date: | 06/12/2006 |
NPI Last Update Date: | 12/07/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 0110002152 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | VA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |