Individual
DR. BEN E JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9205 SW BARNES RD, PORTLAND, OR 97225-6603
(503) 216-4830
Mailing address
PO BOX 25184, PORTLAND, OR 97298-0184
(503) 292-9108
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A72246
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A722460
—
CA
Enumeration date
05/18/2006
Last updated
09/04/2007
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