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General NPI Number Information
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NPI Number | 1023507035
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Entity Type | Individual
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Provider Name | JACOB ANDERSON DO
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Gender | Male
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 3911 AVENUE B
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City | SCOTTSBLUFF
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State | NE
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Zip | 69361-4617
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Country | US
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Telephone | 308-630-2100
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Fax | 308-630-1349
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Provider Business Mailing Address
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Address Line | 260895 COUNTY RD E # 1
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City | SCOTTSBLUFF
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State | NE
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Zip | 69361-6907
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Country | US
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Telephone | 435-754-8044
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3013
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0063543
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License Number State | CO
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