Provider Demographics
NPI:1033291323
Name:JACOBSON, SIG-LINDA (MD)
Entity Type:Individual
Prefix:
First Name:SIG-LINDA
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 SW MARTHA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-1835
Mailing Address - Country:US
Mailing Address - Phone:503-806-7854
Mailing Address - Fax:
Practice Address - Street 1:5006 SW MARTHA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-1835
Practice Address - Country:US
Practice Address - Phone:503-806-7854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68921207VM0101X
UT7805936-1205207VM0101X
NE27129207VM0101X
ORMD15777207VM0101X
IDM-11174207VM0101X
HI16723207VM0101X
NY258455207VM0101X
WA00047437207VM0101X
MO2011011924207VM0101X
IN01074807A207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0085221Medicaid
OR160055377OtherRAILROAD MEDICARE
AKMD2637RMedicaid
OR027094Medicaid
IN300050370Medicaid
ININ1776461OtherMCR
ID807008800Medicaid
WA8201691Medicaid
OR93125743797239E020OtherTRIWEST