MEDICARE: DR. SCOTT NEIL JACOBSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	13465	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5315026203	OTHER	MI	CONTROLLED SUBST LICENSE
2	4301087602	OTHER	MI	ED LIMITED LICENSE

General Provider Information

NPI Number	:	1366658965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT NEIL JACOBSON MD

Provider Business Mailing Address
First Line	:	10120 S EASTERN AVE STE 130
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-3953
Country	:	US
Telephone Number	:	702-970-1111
Fax Number	:	702-688-4373

Provider Business Practice Location Address
First Line	:	10120 S EASTERN AVE STE 130
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052
Country	:	US
Telephone Number	:	702-970-1111
Fax Number	:	702-688-4373

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/16/2018

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