Provider Demographics
NPI:1366658965
Name:JACOBSON, SCOTT NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:NEIL
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10120 S EASTERN AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3953
Mailing Address - Country:US
Mailing Address - Phone:702-970-1111
Mailing Address - Fax:702-688-4373
Practice Address - Street 1:10120 S EASTERN AVE STE 130
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-970-1111
Practice Address - Fax:702-688-4373
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2018-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV13465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315026203OtherCONTROLLED SUBST LICENSE
MI4301087602OtherED LIMITED LICENSE