Individual
DR. ERIC S JACOBSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 W. FORT ST., # 111, BOISE, ID 83702
(208) 422-1000
(208) 422-1319
Mailing address
500 W. FORT ST., # 111, BOISE, ID 83702
(208) 422-1000
(208) 422-1319
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M8480
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010139751
BLUE SHIELD
ID
05
—
003760600
—
ID
01
—
50450
BLUE CROSS
ID
Enumeration date
10/03/2006
Last updated
03/04/2022
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