Provider Demographics
NPI:1558475681
Name:JACOBSON, JON S (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:S
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 1:7245 E OSBORN RD STE 4
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6443
Mailing Address - Country:US
Mailing Address - Phone:480-994-5012
Mailing Address - Fax:602-216-3000
Practice Address - Street 1:7245 E OSBORN RD STE 4
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6443
Practice Address - Country:US
Practice Address - Phone:480-994-5012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14654207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ$$$$$$$$$Medicare PIN