Provider Demographics
NPI:1750379954
Name:JACOBS, JASON MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MATTHEW
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5493
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5493
Mailing Address - Country:US
Mailing Address - Phone:303-282-5467
Mailing Address - Fax:303-777-7681
Practice Address - Street 1:950 E HARVARD AVE
Practice Address - Street 2:STE 320
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-7009
Practice Address - Country:US
Practice Address - Phone:303-282-5467
Practice Address - Fax:303-777-7681
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38008207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12378801Medicaid
COC804422Medicare PIN
H43072Medicare UPIN
COP00304759Medicare PIN