Organization
CHARLES A JACOBSON MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES A JACOBSON M.D. (OWNER)
(208) 883-2828
Entity
Organization
Contact information
Practice address
2500 W A ST, SUITE 201, MOSCOW, ID 83843-6000
(208) 883-2828
(208) 882-2179
Mailing address
2500 W A ST, SUITE 201, MOSCOW, ID 83843-6000
(208) 883-2828
(208) 882-2179
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M6567
ID
Other
Enumeration date
01/26/2007
Last updated
08/19/2014
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