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NPI Code Detail

MEDICARE: WILLIAM C. JACOBSON MD PC

MEDICARE: WILLIAM C. JACOBSON MD PC
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
1207XX0005XSports Medicine (Orthopaedic Surgery) Physician33389IA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CR0838OTHERIARAILROAD MEDICARE

General Provider Information

NPI Number : 1922219047
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLIAM C. JACOBSON MD PC
Provider Business Mailing Address
First Line : 1601 NW 114TH ST
Second Line : SUITE 142
City : DES MOINES
State : IA
Zip : 50325-7007
Country : US
Telephone Number : 515-440-2676
Fax Number : 515-440-2676
Provider Business Practice Location Address
First Line : 1601 NW 114TH ST
Second Line : SUITE 142
City : DES MOINES
State : IA
Zip : 50325-7007
Country : US
Telephone Number : 515-440-2676
Fax Number : 515-440-2676
Authorized Official
Title or Position : PRESIDENT
Name : DR. WILLIAM C JACOBSON
Credential : MD
Telephone Number : 515-440-2676
Provider Enumeration Date : 05/24/2007
Last Update Date : 05/06/2009

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Directions to “WILLIAM C. JACOBSON MD PC ” Practice Location

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