Individual
DR. DALE GARY JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
525 KENOSHA ST, #A, WALWORTH, WI 53184
(262) 275-2101
(262) 275-0752
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 647-6326
(414) 671-8860
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23975
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30394600
—
WI
Enumeration date
08/23/2006
Last updated
03/07/2023
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