Individual
DR. SCOTT NEIL JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10120 S EASTERN AVE STE 130, HENDERSON, NV 89052
(702) 970-1111
(702) 688-4373
Mailing address
10120 S EASTERN AVE STE 130, HENDERSON, NV 89052-3953
(702) 970-1111
(702) 688-4373
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13465
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301087602
ED LIMITED LICENSE
MI
01
—
5315026203
CONTROLLED SUBST LICENSE
MI
Enumeration date
05/14/2007
Last updated
07/16/2018
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