Individual
MADELEINE JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
91 ILLINOIS AVE, PENROSE, CO 81240-9683
(719) 372-6555
(719) 372-6559
Mailing address
91 ILLINOIS AVE, PENROSE, CO 81240-9683
(719) 372-6555
(719) 372-6559
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27100
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01271006
—
CO
Enumeration date
02/21/2006
Last updated
07/01/2010
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