Individual
MR. MICHAEL D JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2121 E HARMONY RD, SUITE 300, FORT COLLINS, CO 80528-3400
(970) 224-9102
(970) 224-9112
Mailing address
2121 E HARMONY RD, SUITE 300, FORT COLLINS, CO 80528-3400
(970) 224-9102
(970) 224-9112
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
0110002152
VA
363AM0700X
Medical Physician Assistant
Primary
PA.0004358
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19730136
—
CO
Enumeration date
06/12/2006
Last updated
08/16/2016
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