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General NPI Number Information
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NPI Number | 1760893069
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Entity Type | Individual
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Provider Name | BILL JACOBSEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2014
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 908 SYRACUSE ST
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City | DENVER
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State | CO
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Zip | 80230-7073
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Country | US
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Telephone | 402-415-6367
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Fax |
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Provider Business Mailing Address
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Address Line | 240 W THOMAS RD STE 301
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City | PHOENIX
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State | AZ
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Zip | 85013-4407
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Country | US
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Telephone | 602-406-6262
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Fax | 602-406-6261
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 56864
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | R74672
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME158475
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | CDRH.0001875
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License Number State | CO
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