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General NPI Number Information
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NPI Number | 1962623447
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Entity Type | Individual
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Provider Name | BRENT R JACOBSON DO
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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 | 06/24/2013
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Provider Practice Location Address
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Address Line | 8647 COACHLIGHT WAY
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City | LITTLETON
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State | CO
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Zip | 80125-9651
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Country | US
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Telephone | 303-933-8270
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Fax | 214-712-2002
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Provider Business Mailing Address
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Address Line | 13737 NOEL RD STE 1600 ATTN: RAYS
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City | DALLAS
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State | TX
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Zip | 75240-1374
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Country | US
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Telephone | 303-933-8270
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Fax | 214-712-2002
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 125-051980
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4176
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | DR-50945
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License Number State | CO
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