Provider Demographics
NPI:1932205259
Name:JACOBSON, DEBORAH LEE (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEE
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9331 S COLORADO BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-7467
Mailing Address - Country:US
Mailing Address - Phone:303-471-4711
Mailing Address - Fax:303-471-4767
Practice Address - Street 1:9331 S COLORADO BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-7467
Practice Address - Country:US
Practice Address - Phone:303-471-4711
Practice Address - Fax:303-471-4767
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39161207Q00000X
CODR.0039161207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO296620YL5BOtherMEDICARE ID EPN
CO36724050Medicaid
CO36724050Medicaid
H66993Medicare UPIN