MEDICARE: WILLIAM M JACOBSEN MD

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	208200000X	Plastic Surgery Physician	21620	AZ

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

General Provider Information

NPI Number	:	1639176894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM M JACOBSEN MD

Provider Business Mailing Address
First Line	:	2400 E ARIZONA BILTMORE CIR
Second Line	:	SUITE 2450
City	:	PHOENIX
State	:	AZ
Zip	:	85016-2107
Country	:	US
Telephone Number	:	602-212-0100
Fax Number	:	602-279-1701

Provider Business Practice Location Address
First Line	:	2400 E ARIZONA BILTMORE CIR
Second Line	:	SUITE 2450
City	:	PHOENIX
State	:	AZ
Zip	:	85016-2107
Country	:	US
Telephone Number	:	602-212-0100
Fax Number	:	602-279-1701

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

Provider Enumeration Date	:	07/02/2005
Last Update Date	:	07/08/2007

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Practice Fax: 602-279-1701

Directions to “ WILLIAM M JACOBSEN MD” Practice Location

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