Provider Demographics
NPI:1497736177
Name:JACOBSON, MICHAEL CRAIG (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CRAIG
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 S EAGLE RD STE 3112
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6352
Practice Address - Country:US
Practice Address - Phone:208-706-5800
Practice Address - Fax:208-706-5810
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA97915208800000X
ID6671934208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology