Individual
THOMAS E JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 HIGHWAY 12, HETTINGER, ND 58639
(701) 567-4561
Mailing address
1100 HIGHWAY 12, HETTINGER, ND 58639-7533
(701) 567-6130
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2916
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10775
ND BC/BS
—
01
—
123993
WORKERS COMP
—
05
—
12564
—
ND
01
—
20818
SIOUX VALLEY
—
05
—
3018140
—
WA
05
—
45034068812
—
NE
05
—
7774910
—
SD
Enumeration date
10/03/2006
Last updated
07/08/2007
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