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General NPI Number Information
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NPI Number | 1639390651
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Entity Type | Individual
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Provider Name | MICHAEL DUANE JACOBSON D.O. MPH
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 04/05/2018
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Provider Practice Location Address
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Address Line | 2261 PHILADELPHIA DR
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City | DAYTON
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State | OH
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Zip | 45406-1814
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Country | US
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Telephone | 937-734-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 4222 TYLERSVILLE RD
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City | WEST CHESTER
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State | OH
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Zip | 45011-8634
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Country | US
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Telephone | 513-860-1099
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Fax | 888-615-8287
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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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 34. 005720
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License Number State | OH
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