MEDICARE: EARL JACOBSON DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	43	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	756480688	OTHER		PALMETTO GBA RAILROAD MED

General Provider Information

NPI Number	:	1487682662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EARL JACOBSON DPM

Provider Business Mailing Address
First Line	:	3650 S EASTERN AVE
Second Line	:	# 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3345
Country	:	US
Telephone Number	:	702-384-2544
Fax Number	:	702-384-8528

Provider Business Practice Location Address
First Line	:	3650 S EASTERN AVE
Second Line	:	# 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3345
Country	:	US
Telephone Number	:	702-384-2544
Fax Number	:	702-384-8528

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	04/01/2024

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