Provider Demographics
NPI:1982051280
Name:JACOBSON, JOSEPH ELMER (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ELMER
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:ELMER
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-216-5633
Mailing Address - Fax:704-639-0785
Practice Address - Street 1:810 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-6253
Practice Address - Country:US
Practice Address - Phone:704-216-5633
Practice Address - Fax:704-639-0785
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11018692207X00000X
NC2022-00307207X00000X, 207XX0004X
GA87991207X00000X
IN11018692A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program