MEDICARE: DEBORAH LEE JACOBSON 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	207Q00000X	Family Medicine Physician	39161	CO
2	207QS0010X	Sports Medicine (Family Medicine) Physician	DR.0039161	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	296620YL5B	OTHER	CO	MEDICARE ID EPN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932205259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH LEE JACOBSON MD

Provider Business Mailing Address
First Line	:	9331 S COLORADO BLVD
Second Line	:	SUITE 200
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80126-7467
Country	:	US
Telephone Number	:	303-471-4711
Fax Number	:	303-471-4767

Provider Business Practice Location Address
First Line	:	9331 S COLORADO BLVD
Second Line	:	SUITE 200
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80126-7467
Country	:	US
Telephone Number	:	303-471-4711
Fax Number	:	303-471-4767

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	08/18/2014

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