Provider Demographics
NPI:1457930265
Name:JACOBSEN, CORY J (MD)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:J
Last Name:JACOBSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-ZDM-M
Mailing Address - Street 2:INTERNAL MEDICINE RESIDENCY, 3551 ROGER BROOKE DR.
Mailing Address - City:JBSA-FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-292-7805
Mailing Address - Fax:210-292-7868
Practice Address - Street 1:57950 LEAVENWORTH ST
Practice Address - Street 2:
Practice Address - City:MCCONNELL AFB
Practice Address - State:KS
Practice Address - Zip Code:67221-3505
Practice Address - Country:US
Practice Address - Phone:316-759-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101276392208D00000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice