Provider Demographics
NPI:1497736177
Name:JACOBSON, MICHAEL CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CRAIG
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 E 31ST ST
Mailing Address - Street 2:ALAMEDA COUNTY MEDICAL CENTER-DEPARTMENT OF SURGERY
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1018
Mailing Address - Country:US
Mailing Address - Phone:510-437-4965
Mailing Address - Fax:510-437-5127
Practice Address - Street 1:1411 E 31ST ST
Practice Address - Street 2:ALAMEDA COUNTY MEDICAL CENTER-DEPARTMENT OF SURGERY
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1018
Practice Address - Country:US
Practice Address - Phone:510-437-4965
Practice Address - Fax:510-437-5127
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97915208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology