Provider Demographics
NPI:1679843163
Name:JACOBS, HERBERT LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:LEON
Last Name:JACOBS
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 1:121 S CLERMONT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1036
Mailing Address - Country:US
Mailing Address - Phone:303-399-0022
Mailing Address - Fax:203-399-1679
Practice Address - Street 1:121 S CLERMONT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1036
Practice Address - Country:US
Practice Address - Phone:303-399-0022
Practice Address - Fax:303-399-1679
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO157682083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine