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General NPI Number Information
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NPI Number | 1366674194
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Entity Type | Organization
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Legal Business Name | DR EARL JACOBSON LTD FOOT CARE CLINIC
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Dates
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Enumeration Date | 08/12/2009
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 3650 S. EASTERN AVE SUITE 200
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City | LAS VEGAS
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State | NV
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Zip | 89169-3345
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Country | US
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Telephone | 702-384-2544
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Fax | 702-384-8528
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Provider Business Mailing Address
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Address Line | 3650 S. EASTERN AVE SUITE 200
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City | LAS VEGAS
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State | NV
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Zip | 89169-3345
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EARL JACOBSON
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Credential |
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Telephone | 702-384-2544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | 43
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License Number State | NV
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