Provider Demographics
NPI:1508204777
Name:JACOBSON, LEE S (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:S
Last Name:JACOBSON
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Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:1 DEACONESS RD
Mailing Address - Street 2:DEPT. OF EMERGENCY MEDICINE, W-CC2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5321
Mailing Address - Country:US
Mailing Address - Phone:617-754-2323
Mailing Address - Fax:617-754-2350
Practice Address - Street 1:1 DEACONESS RD
Practice Address - Street 2:DEPT. OF EMERGENCY MEDICINE, W-CC2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5321
Practice Address - Country:US
Practice Address - Phone:617-754-2323
Practice Address - Fax:617-754-2350
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
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Provider Licenses
StateLicense IDTaxonomies
MA255696207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine