Provider Demographics
NPI:1275761520
Name:JACOBSEN, TORSTEN P (MD)
Entity Type:Individual
Prefix:
First Name:TORSTEN
Middle Name:P
Last Name:JACOBSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3720 SUNSET LANE
Mailing Address - Street 2:SUITE #A
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509
Mailing Address - Country:US
Mailing Address - Phone:925-706-7788
Mailing Address - Fax:925-706-7988
Practice Address - Street 1:3720 SUNSET LANE
Practice Address - Street 2:SUITE #A
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509
Practice Address - Country:US
Practice Address - Phone:925-706-7788
Practice Address - Fax:925-706-7988
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
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Provider Licenses
StateLicense IDTaxonomies
CAA23709207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23646Medicare UPIN