Provider Demographics
NPI:1598858979
Name:JACOBSON, NEAL R (DO)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:R
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:541-523-8111
Mailing Address - Fax:541-523-1738
Practice Address - Street 1:3325 POCAHONTAS ROAD
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814
Practice Address - Country:US
Practice Address - Phone:541-523-8111
Practice Address - Fax:541-523-1738
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2013-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORDO17381207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine